Healthcare Provider Details

I. General information

NPI: 1265123749
Provider Name (Legal Business Name): SUKALPA JOHN DUTTA, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18012 WIKA RD
APPLE VALLEY CA
92307-2125
US

IV. Provider business mailing address

18092 WIKA RD STE 220
APPLE VALLEY CA
92307-2132
US

V. Phone/Fax

Practice location:
  • Phone: 442-292-2358
  • Fax: 949-404-6801
Mailing address:
  • Phone: 760-515-6260
  • Fax: 949-863-8505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUKALPA DUTTA
Title or Position: PRESIDENT
Credential: MD
Phone: 310-497-1070