MEDICARE: DR. TYISHA LYNN SEYMOUR M.D.

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	208000000X	Pediatrics Physician	A120623	CA

General Provider Information

NPI Number	:	1568775682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TYISHA LYNN SEYMOUR M.D.

Provider Business Mailing Address
First Line	:	3653 S SEPULVEDA BLVD APT 3
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-6819
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3831 HUGHES AVE STE 601
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90232-6844
Country	:	US
Telephone Number	:	310-838-4048
Fax Number	:	310-425-8091

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

Provider Enumeration Date	:	07/18/2010
Last Update Date	:	01/06/2026

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