Healthcare Provider Details

I. General information

NPI: 1104147149
Provider Name (Legal Business Name): KIRAN GUPTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 SACRAMENTO ST
SAN FRANCISCO CA
94115-2383
US

IV. Provider business mailing address

PO BOX 276950
SACRAMENTO CA
95827-6950
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-6830
  • Fax: 415-375-4844
Mailing address:
  • Phone: 866-681-0738
  • Fax: 916-854-6769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberA137867
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: