Healthcare Provider Details

I. General information

NPI: 1528009396
Provider Name (Legal Business Name): FREMONT MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 MOWRY AVE
FREMONT CA
94536-4115
US

IV. Provider business mailing address

734 MOWRY AVE
FREMONT CA
94536-4115
US

V. Phone/Fax

Practice location:
  • Phone: 510-793-3033
  • Fax: 510-793-4952
Mailing address:
  • Phone: 510-793-3033
  • Fax: 510-793-4952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG4628
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG6855
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA44320
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberA53697
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberG66303
License Number StateCA

VIII. Authorized Official

Name: JANIS SHIKANO
Title or Position: OFFICE MANAGER
Credential:
Phone: 510-793-3033