Basic Information
| Provider Information | |||||||||
| NPI: | 1225032048 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HYMES | ||||||||
| FirstName: | JAYSON | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6815 NOBLE AVE | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914053796 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187816684 | ||||||||
| FaxNumber: | 8187814457 | ||||||||
| Practice Location | |||||||||
| Address1: | 6815 NOBLE AVE | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914053796 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187816684 | ||||||||
| FaxNumber: | 8187814457 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2005 | ||||||||
| LastUpdateDate: | 03/06/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | G056728 | CA | Y | Other Service Providers | Specialist |
No ID Information.