Healthcare Provider Details

I. General information

NPI: 1518686765
Provider Name (Legal Business Name): BAY AREA REHAB & MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34261 FREMONT BLVD
FREMONT CA
94555-3300
US

IV. Provider business mailing address

34261 FREMONT BLVD
FREMONT CA
94555-3300
US

V. Phone/Fax

Practice location:
  • Phone: 510-818-1668
  • Fax: 510-796-1269
Mailing address:
  • Phone: 510-818-1668
  • Fax: 510-796-1269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KENNY DUONG
Title or Position: OWNER
Credential: DC
Phone: 510-299-3695