Provider Demographics
NPI:1649241050
Name:HARVEY HASHIMOTO MD INC
Entity Type:Organization
Organization Name:HARVEY HASHIMOTO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HASHIMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-333-8066
Mailing Address - Street 1:PO BOX 986
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:95258-0986
Mailing Address - Country:US
Mailing Address - Phone:209-333-8066
Mailing Address - Fax:209-333-1029
Practice Address - Street 1:801 S HAM LN
Practice Address - Street 2:#5
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242
Practice Address - Country:US
Practice Address - Phone:209-333-8066
Practice Address - Fax:209-333-1029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG55355207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG553550Medicaid
CAOOG553550Medicaid
A52929Medicare UPIN