Provider Demographics
NPI:1104942762
Name:HYMAN, KENNETH MARK (PA-C, DC)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:MARK
Last Name:HYMAN
Suffix:
Gender:M
Credentials:PA-C, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3329 ERICA PL
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-8320
Mailing Address - Country:US
Mailing Address - Phone:805-588-0161
Mailing Address - Fax:
Practice Address - Street 1:3329 ERICA PL
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-8320
Practice Address - Country:US
Practice Address - Phone:805-588-0161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19078363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical