MEDICARE: DR. JACOB LYON DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0401X	Addiction Medicine (Family Medicine) Physician	3601	WV
2	207Q00000X	Family Medicine Physician	OS22863	FL

General Provider Information

NPI Number	:	1194254441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACOB LYON DO

Provider Business Mailing Address
First Line	:	6255 W SUNSET BLVD FL 21
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-7422
Country	:	US
Telephone Number	:	323-860-5200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1613 ALTON RD # 2
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-2420
Country	:	US
Telephone Number	:	305-538-1400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2017
Last Update Date	:	02/19/2026

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