Healthcare Provider Details

I. General information

NPI: 1164049987
Provider Name (Legal Business Name): JULIAN K HINSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2020
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 BROCKTON AVE STE 302
RIVERSIDE CA
92506-0172
US

IV. Provider business mailing address

4646 BROCKTON AVE STE 203
RIVERSIDE CA
92506-0104
US

V. Phone/Fax

Practice location:
  • Phone: 951-774-2881
  • Fax:
Mailing address:
  • Phone: 951-774-2881
  • Fax: 951-228-0158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA191899
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: