Healthcare Provider Details

I. General information

NPI: 1811073323
Provider Name (Legal Business Name): SUMAN S. KUPPAHALLY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15215 NATIONAL AVE STE 105
LOS GATOS CA
95032-2425
US

IV. Provider business mailing address

15215 NATIONAL AVE STE 105
LOS GATOS CA
95032-2425
US

V. Phone/Fax

Practice location:
  • Phone: 408-358-3458
  • Fax: 408-356-6191
Mailing address:
  • Phone: 408-358-3458
  • Fax: 408-356-6191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA72494
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA72494
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: