Provider Demographics
NPI:1538133731
Name:HYSEN, JANE LESLIE (PA)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:LESLIE
Last Name:HYSEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 30TH ST
Mailing Address - Street 2:SUITE 540
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3424
Mailing Address - Country:US
Mailing Address - Phone:510-836-0223
Mailing Address - Fax:510-836-8791
Practice Address - Street 1:350 30TH ST
Practice Address - Street 2:DAVID LOUIS MD #540
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3424
Practice Address - Country:US
Practice Address - Phone:510-836-0223
Practice Address - Fax:510-836-8791
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA10463363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPA104630OtherPAUPIN
CAGR0028630Medicaid
CAZZZ16371ZMedicare ID - Type Unspecified