Provider Demographics
NPI:1356383350
Name:GROSS, HYMAN (MD)
Entity type:Individual
Prefix:
First Name:HYMAN
Middle Name:
Last Name:GROSS
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 1:2021 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 320E
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2208
Mailing Address - Country:US
Mailing Address - Phone:310-998-2287
Mailing Address - Fax:310-998-2247
Practice Address - Street 1:2021 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 320E
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2208
Practice Address - Country:US
Practice Address - Phone:310-998-2287
Practice Address - Fax:310-998-2247
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA91135Medicare UPIN
CAG28495Medicare ID - Type Unspecified