Provider Demographics
NPI:1821137274
Name:ASIAN MEDICAL CLINIC FREMONT INC
Entity Type:Organization
Organization Name:ASIAN MEDICAL CLINIC FREMONT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-770-1300
Mailing Address - Street 1:PO BOX 14858
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-1858
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:46356 WARM SPRINGS BLVD
Practice Address - Street 2:SUITE 872
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-7021
Practice Address - Country:US
Practice Address - Phone:510-770-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44210207Q00000X
CAA76340207R00000X
CAG48660207RC0000X
CAC41936208D00000X
CAC28271208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0098780Medicaid
CAZZZ23224ZMedicare ID - Type UnspecifiedAMC GROUP MEDICARE