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General NPI Number Information
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NPI Number | 1396211926
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Entity Type | Organization
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Legal Business Name | FREMONT ORAL & MAXILLOFACIAL SURGERY
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Dates
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Enumeration Date | 10/22/2018
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 4545 MATTOS DR
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City | FREMONT
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State | CA
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Zip | 94536-6736
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Country | US
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Telephone | 510-792-9405
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Fax | 510-792-0212
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Provider Business Mailing Address
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Address Line | 4545 MATTOS DR
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City | FREMONT
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State | CA
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Zip | 94536-6736
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Country | US
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Telephone | 510-792-9405
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Fax | 510-792-0212
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LINN MAUNG
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Credential | MD, DDS
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Telephone | 510-220-5349
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number |
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License Number State |
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