Provider Demographics
NPI:1225032048
Name:HYMES, JAYSON A (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYSON
Middle Name:A
Last Name:HYMES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6815 NOBLE AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3796
Mailing Address - Country:US
Mailing Address - Phone:818-781-6684
Mailing Address - Fax:818-781-4457
Practice Address - Street 1:6815 NOBLE AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3796
Practice Address - Country:US
Practice Address - Phone:818-781-6684
Practice Address - Fax:818-781-4457
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG056728174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG56728FMedicare PIN