Healthcare Provider Details

I. General information

NPI: 1982864617
Provider Name (Legal Business Name): JASON D HINMAN M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MEDICAL PLZ SUITE B200
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

300 MEDICAL PLZ SUITE B200
LOS ANGELES CA
90095-0001
US

V. Phone/Fax

Practice location:
  • Phone: 310-794-1195
  • Fax: 310-794-7491
Mailing address:
  • Phone: 310-794-1195
  • Fax: 310-794-7491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberA106491
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA106491
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: