Individual
JACK H. DYM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10200 SEPULVEDA BLVD, SUITE 200, MISSION HILLS, CA 91345-2649
(818) 893-6949
(818) 892-2546
Mailing address
3050 E AIRPORT WAY, LONG BEACH, CA 90806-2404
(562) 426-9661
(562) 426-4227
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
G18786
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G187860
MEDI-CAL
CA
Enumeration date
09/28/2006
Last updated
07/08/2007
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