Healthcare Provider Details

I. General information

NPI: 1255388666
Provider Name (Legal Business Name): KEVIN JEFFREY MITCHELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MOWRY AVE
FREMONT CA
94538-1716
US

IV. Provider business mailing address

2000 MOWRY AVE
FREMONT CA
94538-1716
US

V. Phone/Fax

Practice location:
  • Phone: 510-248-1018
  • Fax:
Mailing address:
  • Phone: 510-248-1018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberG86712
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: