Provider Demographics
NPI:1578506952
Name:HASHIMOTO, HARVEY (MD)
Entity Type:Individual
Prefix:
First Name:HARVEY
Middle Name:
Last Name:HASHIMOTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 241011
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95241-9511
Mailing Address - Country:US
Mailing Address - Phone:209-339-7435
Mailing Address - Fax:209-333-3054
Practice Address - Street 1:2415 W VINE ST
Practice Address - Street 2:SUITE 105
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-3731
Practice Address - Country:US
Practice Address - Phone:209-339-7435
Practice Address - Fax:209-333-3054
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55355207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G553550Medicaid
CA00G553550Medicare PIN
A52929Medicare UPIN