Healthcare Provider Details

I. General information

NPI: 1578022422
Provider Name (Legal Business Name): FAKHAR ABBAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38143 MARTHA AVE
FREMONT CA
94536-3800
US

IV. Provider business mailing address

262 LLANO DE LOS ROBLES AVE
SAN JOSE CA
95136-4988
US

V. Phone/Fax

Practice location:
  • Phone: 408-689-8761
  • Fax: 408-689-8761
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036162883
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA176623
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: