Healthcare Provider Details

I. General information

NPI: 1851902506
Provider Name (Legal Business Name): MEGHA KOTHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 MOWRY AVE STE 201
FREMONT CA
94538-1730
US

IV. Provider business mailing address

45128 WARM SPRINGS BLVD UNIT 334
FREMONT CA
94539-6131
US

V. Phone/Fax

Practice location:
  • Phone: 925-685-4224
  • Fax:
Mailing address:
  • Phone: 408-712-7805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberA201882
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA201882
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: