Healthcare Provider Details

I. General information

NPI: 1225032048
Provider Name (Legal Business Name): JAYSON A HYMES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6815 NOBLE AVE SUITE 105
VAN NUYS CA
91405-3796
US

IV. Provider business mailing address

6815 NOBLE AVE SUITE 105
VAN NUYS CA
91405-3796
US

V. Phone/Fax

Practice location:
  • Phone: 818-781-6684
  • Fax: 818-781-4457
Mailing address:
  • Phone: 818-781-6684
  • Fax: 818-781-4457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG056728
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: