Provider Demographics
NPI:1669413365
Name:FREMONT INTERNAL MEDICINE MEDICAL ASSOCIATES,INC
Entity type:Organization
Organization Name:FREMONT INTERNAL MEDICINE MEDICAL ASSOCIATES,INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NOREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-468-1533
Mailing Address - Street 1:160 J ST UNIT 2656
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-8018
Mailing Address - Country:US
Mailing Address - Phone:510-468-1533
Mailing Address - Fax:510-343-6504
Practice Address - Street 1:556 MOWRY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-4186
Practice Address - Country:US
Practice Address - Phone:510-796-0770
Practice Address - Fax:510-796-7099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48148207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A481480Medicaid
CAE58823Medicare UPIN
CA00A481480Medicaid