Healthcare Provider Details

I. General information

NPI: 1760724371
Provider Name (Legal Business Name): OPAL KAMDAR GUPTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: OPAL KAMDAR MD

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 SUTTER ST RM 933
SAN FRANCISCO CA
94108
US

IV. Provider business mailing address

450 SUTTER ST RM 933
SAN FRANCISCO CA
94108-3997
US

V. Phone/Fax

Practice location:
  • Phone: 415-362-5443
  • Fax: 415-362-5444
Mailing address:
  • Phone: 415-362-5443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036140728
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA154818
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: