Healthcare Provider Details

I. General information

NPI: 1831848910
Provider Name (Legal Business Name): GAGAN KOONER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 34TH ST STE 100&200
BAKERSFIELD CA
93301-2305
US

IV. Provider business mailing address

11905 BOLTHOUSE DR STE 500&600
BAKERSFIELD CA
93311-8494
US

V. Phone/Fax

Practice location:
  • Phone: 833-678-2781
  • Fax: 661-368-0618
Mailing address:
  • Phone: 833-678-2781
  • Fax: 661-328-4029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA197548
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: