Healthcare Provider Details

I. General information

NPI: 1952096539
Provider Name (Legal Business Name): KUNAL KUMAR GUPTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

986 OLDE STERLING WAY
DAYTON OH
45459-3100
US

IV. Provider business mailing address

986 OLDE STERLING WAY
DAYTON OH
45459-3100
US

V. Phone/Fax

Practice location:
  • Phone: 937-838-3784
  • Fax:
Mailing address:
  • Phone: 937-838-3784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD600006266
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.156887
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: