Healthcare Provider Details

I. General information

NPI: 1194390096
Provider Name (Legal Business Name): GURPAL HOONJAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 05/08/2025
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4233 MAPLE RD
AMHURST NY
14226
US

IV. Provider business mailing address

4233 MAPLE RD
AMHURST NY
14226
US

V. Phone/Fax

Practice location:
  • Phone: 716-631-2728
  • Fax:
Mailing address:
  • Phone: 716-631-2728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number062442
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: