Healthcare Provider Details

I. General information

NPI: 1821137274
Provider Name (Legal Business Name): ASIAN MEDICAL CLINIC FREMONT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 05/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46356 WARM SPRINGS BLVD SUITE 872
FREMONT CA
94539-7021
US

IV. Provider business mailing address

PO BOX 14858
FREMONT CA
94539-1858
US

V. Phone/Fax

Practice location:
  • Phone: 510-770-1300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG44210
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG48660
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberC41936
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberC28271
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA76340
License Number StateCA

VIII. Authorized Official

Name: DR. EVELYN E LI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 510-770-1300