Organization
EVERGREEN HILLS MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD SIAO M.D. (CEO)
(408) 223-7771
Entity
Organization
Contact information
Practice address
2690 S WHITE RD, SUITE 200, SAN JOSE, CA 95148-2076
(408) 223-7771
(408) 223-7779
Mailing address
2690 S WHITE RD, SUITE 200, SAN JOSE, CA 95148-2076
(408) 223-7771
(408) 223-7779
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A67291
STATE LICENSE NUMBER
CA
01
—
A73641
STATE LICENSE NUMBER
CA
01
—
G69952
STATE LICENSE NUMBER
CA
01
—
G73395
STATE LICENSE NUMBER
CA
Enumeration date
06/11/2007
Last updated
08/22/2020
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