Healthcare Provider Details

I. General information

NPI: 1225558349
Provider Name (Legal Business Name): FORREST ROBERT HAMLIN SR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date: 03/27/2019
Reactivation Date: 05/20/2019

III. Provider practice location address

415 E TAYLOR ST
SAN JOSE CA
95112
US

IV. Provider business mailing address

415 E TAYLOR ST
SAN JOSE CA
95112
US

V. Phone/Fax

Practice location:
  • Phone: 530-224-9144
  • Fax:
Mailing address:
  • Phone: 530-224-9144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberO-1860
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMED-PHYS-LIC-162063
License Number StateMT
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number17023
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMED-PHYS-LIC-162063
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: