Healthcare Provider Details

I. General information

NPI: 1427002666
Provider Name (Legal Business Name): MALKEET GUPTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 WESTWOOD PLZ RM 14-19
LOS ANGELES CA
90095-3075
US

IV. Provider business mailing address

5767 W CENTURY BLVD #400
LOS ANGELES CA
90045-5655
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-2111
  • Fax:
Mailing address:
  • Phone: 310-825-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberA87246
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: