Organization
FREMONT MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANIS SHIKANO (OFFICE MANAGER)
(510) 793-3033
Entity
Organization
Contact information
Practice address
734 MOWRY AVE, FREMONT, CA 94536-4115
(510) 793-3033
(510) 793-4952
Mailing address
734 MOWRY AVE, FREMONT, CA 94536-4115
(510) 793-3033
(510) 793-4952
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
G4628
CA
207R00000X
Internal Medicine Physician
G6855
CA
207RC0000X
Cardiovascular Disease Physician
A44320
CA
207RG0100X
Gastroenterology Physician
Primary
G66303
CA
207RR0500X
Rheumatology Physician
A53697
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0077610
—
CA
01
—
ZZZ46056Z
BLUE SHIELD
CA
Enumeration date
06/10/2006
Last updated
09/11/2025
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