Provider Demographics
NPI:1194802322
Name:HINSDALE, JAMES G (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:G
Last Name:HINSDALE
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 1:2505 SAMARITAN DR STE 601
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4017
Mailing Address - Country:US
Mailing Address - Phone:408-358-1024
Mailing Address - Fax:408-741-0705
Practice Address - Street 1:2505 SAMARITAN DR STE 601
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4017
Practice Address - Country:US
Practice Address - Phone:408-358-1024
Practice Address - Fax:408-741-0705
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G297410208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0027730Medicaid
CAGR0027730Medicaid
CA00G297410Medicare ID - Type Unspecified