Healthcare Provider Details

I. General information

NPI: 1093639502
Provider Name (Legal Business Name): DIVYA GUPTA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41111 MISSION BLVD STE 107
FREMONT CA
94539-3922
US

IV. Provider business mailing address

38902 APPLEGATE TER
FREMONT CA
94536-4256
US

V. Phone/Fax

Practice location:
  • Phone: 510-405-5443
  • Fax: 510-248-0789
Mailing address:
  • Phone: 510-435-9040
  • Fax: 510-248-0789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DIVYA GUPTA
Title or Position: PRESIDENT
Credential: MD
Phone: 510-435-9040