Healthcare Provider Details

I. General information

NPI: 1215295548
Provider Name (Legal Business Name): SEMYON FAYNBOYM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19401 S VERMONT AVE STE K100K
TORRANCE CA
90502-1029
US

IV. Provider business mailing address

3701 SANTA ROSALIA DR STE 1093
LOS ANGELES CA
90008-3603
US

V. Phone/Fax

Practice location:
  • Phone: 323-638-4263
  • Fax:
Mailing address:
  • Phone: 510-304-3875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01076211A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number01076211A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number01076211A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number138237
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: