Healthcare Provider Details

I. General information

NPI: 1225567779
Provider Name (Legal Business Name): YASHA PARIKH GUPTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YASHA PARIKH MD

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 10/14/2023
Certification Date: 10/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 SAN PABLO ST
LOS ANGELES CA
90033-5310
US

IV. Provider business mailing address

PO BOX 31309
LOS ANGELES CA
90031-0309
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-8500
  • Fax:
Mailing address:
  • Phone: 626-457-6601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number430112816
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA186740
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: