Healthcare Provider Details

I. General information

NPI: 1568775682
Provider Name (Legal Business Name): TYISHA LYNN SEYMOUR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2010
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3831 HUGHES AVE STE 601
CULVER CITY CA
90232-6844
US

IV. Provider business mailing address

3653 S SEPULVEDA BLVD APT 3
LOS ANGELES CA
90034-6819
US

V. Phone/Fax

Practice location:
  • Phone: 310-838-4048
  • Fax: 310-425-8091
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA120623
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: