MEDICARE: DR. KAJAL GUPTA M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A-92637	CA

General Provider Information

NPI Number	:	1154461010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAJAL GUPTA M.D

Provider Business Mailing Address
First Line	:	495 E RINCON ST STE 215
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92879-1378
Country	:	US
Telephone Number	:	951-523-0117
Fax Number	:

Provider Business Practice Location Address
First Line	:	4022 CHICAGO AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-5340
Country	:	US
Telephone Number	:	855-505-7467
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	04/25/2023

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