Provider Demographics
NPI:1396211926
Name:FREMONT ORAL & MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:FREMONT ORAL & MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DDS
Authorized Official - Phone:510-220-5349
Mailing Address - Street 1:39210 STATE ST STE 115
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1456
Mailing Address - Country:US
Mailing Address - Phone:510-792-9405
Mailing Address - Fax:
Practice Address - Street 1:39210 STATE ST STE 115
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1456
Practice Address - Country:US
Practice Address - Phone:510-792-9405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty