Individual
EBONY HYSAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Contact information
Practice address
9649 LAKEWOOD BLVD, DOWNEY, CA 90240-3308
(562) 417-7449
(562) 280-2813
Mailing address
PO BOX 4054, LAKEWOOD, CA 90711-4054
(562) 417-7449
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
L9748
CA
Other
Enumeration date
02/26/2026
Last updated
02/26/2026
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