Provider Demographics
NPI:1770519555
Name:GUPTA, CHAKSHU (MD)
Entity type:Individual
Prefix:DR
First Name:CHAKSHU
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9705 LENEXA DR
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-1345
Mailing Address - Country:US
Mailing Address - Phone:816-676-1165
Mailing Address - Fax:816-676-1208
Practice Address - Street 1:4000 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-3488
Practice Address - Country:US
Practice Address - Phone:913-588-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004029637174400000X, 207ZB0001X, 207ZP0101X, 207ZP0102X
KS04-35950207ZB0001X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No174400000XOther Service ProvidersSpecialist
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
34925019OtherBLUE CROSS BLUE SHIELD KC
KS200309840AMedicaid
MO209457803Medicaid
10001797600OtherCOMMUNITY HEALTH PLAN
10001797600OtherCOMMUNITY HEALTH PLAN