Basic Information
Provider Information
NPI: 1508940305
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HERSHON
FirstName: JAMES
MiddleName: JOSEPH
NamePrefix: MR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2351 CLAY ST
Address2: # 501
City: SAN FRANCISCO
State: CA
PostalCode: 94115
CountryCode: US
TelephoneNumber: 4159233421
FaxNumber: 4156001414
Practice Location
Address1: 2351 CLAY ST
Address2: # 501
City: SAN FRANCISCO
State: CA
PostalCode: 94115
CountryCode: US
TelephoneNumber: 4159233421
FaxNumber: 4156001414
Other Information
ProviderEnumerationDate: 10/25/2006
LastUpdateDate: 01/07/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0200XG34963CAY Allopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
207RP1001XG34963CAN Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease

ID Information
IDTypeStateIssuerDescription
00G34963005CA MEDICAID


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