Provider Demographics
NPI:1154836435
Name:MICHAEL J. HYMAN, M.D.,INC.
Entity Type:Organization
Organization Name:MICHAEL J. HYMAN, M.D.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:HYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-906-0635
Mailing Address - Street 1:16311 VENTURA BLVD STE 800
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2140
Mailing Address - Country:US
Mailing Address - Phone:818-906-0635
Mailing Address - Fax:818-906-7303
Practice Address - Street 1:16311 VENTURA BLVD STE 800
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2140
Practice Address - Country:US
Practice Address - Phone:818-906-0635
Practice Address - Fax:818-906-7303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-07
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79203208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA79203OtherCALIFORNIA STATE LICENSE