Basic Information
| Provider Information | |||||||||
| NPI: | 1013682707 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEENA GUPTA MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4945 BRIDGEVIEW LN | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951382702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4086660392 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4945 BRIDGEVIEW LN | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951382702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4086660392 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2021 | ||||||||
| LastUpdateDate: | 09/23/2021 | ||||||||
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| AuthorizedOfficialLastName: | GUPTA | ||||||||
| AuthorizedOfficialFirstName: | LEENA | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4086660392 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 09/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.