Healthcare Provider Details

I. General information

NPI: 1225157985
Provider Name (Legal Business Name): REENA GUPTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8920 WILSHIRE BLVD STE 604
BEVERLY HILLS CA
90211-2006
US

IV. Provider business mailing address

8920 WILSHIRE BLVD STE 604
BEVERLY HILLS CA
90211-2006
US

V. Phone/Fax

Practice location:
  • Phone: 310-736-4272
  • Fax: 310-496-7235
Mailing address:
  • Phone: 310-736-4272
  • Fax: 310-496-7235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number109515
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: