Healthcare Provider Details

I. General information

NPI: 1770519555
Provider Name (Legal Business Name): CHAKSHU GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 CAMBRIDGE ST
KANSAS CITY KS
66160-3488
US

IV. Provider business mailing address

9705 LENEXA DR
LENEXA KS
66215-1345
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-6111
  • Fax:
Mailing address:
  • Phone: 816-676-1165
  • Fax: 816-676-1208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number2004029637
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number04-35950
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number2004029637
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number2004029637
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number2004029637
License Number StateMO
# 6
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number04-35950
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: