Healthcare Provider Details

I. General information

NPI: 1376127068
Provider Name (Legal Business Name): GUNJAN BHAT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2021
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 W LA PALMA AVE STE 705
ANAHEIM CA
92801-2814
US

IV. Provider business mailing address

2742 KINGS CANYON DR
JURUPA VALLEY CA
92509-1920
US

V. Phone/Fax

Practice location:
  • Phone: 714-772-6701
  • Fax: 714-772-5240
Mailing address:
  • Phone: 206-734-7997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number196462
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: