Healthcare Provider Details

I. General information

NPI: 1326190836
Provider Name (Legal Business Name): JED IRA WEISSBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39400 PASEO PADRE PARKWAY KP FREMONT MEDICAL CENTER
FREMONT CA
94538
US

IV. Provider business mailing address

1 KAISER PLZ 27L
OAKLAND CA
94612-3610
US

V. Phone/Fax

Practice location:
  • Phone: 510-271-6847
  • Fax:
Mailing address:
  • Phone: 510-271-6847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberG41647
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: