Active NPI
Evergreen Hills Medical Group
- Medical Specialty Clinic/Center
- San Jose, CA
National Provider Identifier
1396949822
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Specialty Clinic/Center
- Legal business name
- EVERGREEN HILLS MEDICAL GROUP
- Practice address
- 2690 S White Rd
Suite 200
San Jose, CA 95148-2076 - Phone
- (408) 223-7771
- Fax
- (408) 223-7779
- NPI assigned
- Jun 11, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Donald Siao, M.D.
- Title
- Ceo
- Phone
- (408) 223-7771
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Specialty Clinic/Center | 261QM2500X | Primary |
Addresses
Primary practice location
2690 S White Rd
Suite 200
San Jose, CA 95148-2076
Mailing address
2690 S White Rd
Suite 200
San Jose, CA 95148-2076
Phone (408) 223-7771
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A73641 | Other | CA | STATE LICENSE NUMBER |
| G69952 | Other | CA | STATE LICENSE NUMBER |
| A67291 | Other | CA | STATE LICENSE NUMBER |
| G73395 | Other | CA | STATE LICENSE NUMBER |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181520000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1396949822",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2690 S WHITE RD",
"address_2": "SUITE 200",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951482076",
"telephone_number": "408-223-7771",
"fax_number": "408-223-7779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2690 S WHITE RD",
"address_2": "SUITE 200",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951482076",
"telephone_number": "408-223-7771",
"fax_number": "408-223-7779"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EVERGREEN HILLS MEDICAL GROUP",
"organizational_subpart": "NO",
"enumeration_date": "2007-06-11",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "SIAO",
"authorized_official_first_name": "DONALD",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "408-223-7771",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "261QM2500X",
"taxonomy_group": "",
"desc": "Clinic/Center, Medical Specialty",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE NUMBER",
"identifier": "A73641",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE NUMBER",
"identifier": "G69952",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE NUMBER",
"identifier": "A67291",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE NUMBER",
"identifier": "G73395",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
- Evergreen Cardiology Group, Inc
- Evergreen Elementary School District
- Evergreen Eyecare Optometry Inc.
- Evergreen Golden Health Center a Medical Corporation
- Evergreen Hematology Oncology Associates
- Evergreen Medical Associates Inc
- Evergreen Medical Group, Inc.
- Evergreen Natural Healing Arts
- Evergreen Pediatric Associates Inc.
- Evergreen Pediatrics Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.