MEDICARE: MS. JANE LESLIE HYSEN PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA10463	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OPA104630	OTHER	CA	PAUPIN

General Provider Information

NPI Number	:	1538133731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANE LESLIE HYSEN PA

Provider Business Mailing Address
First Line	:	350 30TH ST
Second Line	:	SUITE 540
City	:	OAKLAND
State	:	CA
Zip	:	94609-3424
Country	:	US
Telephone Number	:	510-836-0223
Fax Number	:	510-836-8791

Provider Business Practice Location Address
First Line	:	350 30TH ST
Second Line	:	DAVID LOUIS MD #540
City	:	OAKLAND
State	:	CA
Zip	:	94609-3424
Country	:	US
Telephone Number	:	510-836-0223
Fax Number	:	510-836-8791

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	03/31/2016

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