Healthcare Provider Details

I. General information

NPI: 1922208982
Provider Name (Legal Business Name): RISHI GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 03/09/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

6230 IRVINE BLVD # 404
IRVINE CA
92620-2103
US

V. Phone/Fax

Practice location:
  • Phone: 310-926-4930
  • Fax: 760-859-3877
Mailing address:
  • Phone: 310-926-4930
  • Fax: 760-859-3877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA117486
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMT191678
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2081H0002X
TaxonomyHospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA117486
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: