Active NPI
Jiwan P Gupta, M.D.
- General Practice Physician
- Irvine, CA
National Provider Identifier
1053305458
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- A37323
- Practice address
- 14795 Jeffrey Rd Ste 204
Irvine, CA 92618-0417 - Phone
- (949) 486-4411
- NPI assigned
- Aug 31, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Medicine Clinic/Center | 261QX0100X | A37323 | CA | |
| Anesthesiology Physician | 207L00000X | A37323 | CA | |
| General Practice Physician | 208D00000X | A37323 | CA | Primary |
Addresses
Primary practice location
14795 Jeffrey Rd Ste 204
Irvine, CA 92618-0417
Mailing address
33 Montgomery
Mission Viejo, CA 92692-5115
Phone (949) 648-3878
Other practice location 1
33 Montgomery
Mission Viejo, CA 92692-5115
Phone (949) 648-3878
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080308000065 | CA | Practitioner - General Practice | 8325123862 | Practice locations: Mission Viejo, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A37323 | CA | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620864000000",
"number": "1053305458",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "33 MONTGOMERY",
"city": "MISSION VIEJO",
"state": "CA",
"postal_code": "926925115",
"telephone_number": "949-648-3878",
"fax_number": "949-486-4417"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14795 JEFFREY RD STE 204",
"city": "IRVINE",
"state": "CA",
"postal_code": "926180417",
"telephone_number": "949-486-4411"
}
],
"practiceLocations": [
{
"address_1": "33 Montgomery",
"address_purpose": "LOCATION",
"city": "Mission Viejo",
"state": "CA",
"postal_code": "926925115",
"country_code": "US",
"telephone_number": "949-648-3878",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GUPTA",
"first_name": "JIWAN",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-31",
"last_updated": "2021-05-13",
"certification_date": "2021-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "261QX0100X",
"taxonomy_group": "",
"desc": "Clinic/Center, Occupational Medicine",
"state": "CA",
"license": "A37323",
"primary": false
},
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "CA",
"license": "A37323",
"primary": false
},
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "CA",
"license": "A37323",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Irvine, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.