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General NPI Number Information
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NPI Number | 1326292012
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Entity Type | Organization
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Legal Business Name | FREMONT NEPHROLOGY PROF CORP
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Dates
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Enumeration Date | 11/09/2008
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Last Update Date | 05/18/2012
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Provider Practice Location Address
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Address Line | 39233 LIBERTY ST
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City | FREMONT
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State | CA
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Zip | 94538-1501
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Country | US
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Telephone | 510-795-8186
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Fax | 510-792-8186
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Provider Business Mailing Address
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Address Line | 39270 PASEO PADRE PKWY SUITE 518
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City | FREMONT
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State | CA
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Zip | 94538-1616
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Country | US
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Telephone | 510-795-8186
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Fax | 510-792-8186
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Authorized Official
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Title or Position | CEO
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Name | DAVID T TAY
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Credential | M.D.
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Telephone | 510-501-8681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G63140
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | G63140
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License Number State | CA
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