1669413365 NPI number — FREMONT INTERNAL MEDICINE MEDICAL ASSOCIATES,INC

Table of content: (NPI 1669413365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669413365 NPI number — FREMONT INTERNAL MEDICINE MEDICAL ASSOCIATES,INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FREMONT INTERNAL MEDICINE MEDICAL ASSOCIATES,INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669413365
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
160 J ST UNIT 2656
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREMONT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94536-8018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-468-1533
Provider Business Mailing Address Fax Number:
510-343-6504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
556 MOWRY AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
FREMONT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94536-4186
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-796-0770
Provider Business Practice Location Address Fax Number:
510-796-7099
Provider Enumeration Date:
06/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SINGH
Authorized Official First Name:
NOREEN
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
510-468-1533

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A48148 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A481480 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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