Healthcare Provider Details

I. General information

NPI: 1114583259
Provider Name (Legal Business Name): KASHIKA GUPTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 LAS POSITAS RD
LIVERMORE CA
94551-9627
US

IV. Provider business mailing address

315 MERCY AVE STE 301
MERCED CA
95340-8367
US

V. Phone/Fax

Practice location:
  • Phone: 925-243-2600
  • Fax:
Mailing address:
  • Phone: 209-564-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3129
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: