Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Dr. Tynan Wyatt, MD

Individual provider Family Medicine Physician · NPI 1306231840

Dr. Tynan Wyatt, MD is a Family Practice in San Diego, California. Qualified in 2015, 11 years ago. Practices with Revive Pathway, a 12-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in California.

Years since qualifying
11
Licensed in
CA
In the registry since
2015
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

4077 Fifth Ave # MER35
San Diego, CA 92103-2105
Phone: (619) 691-7587
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 4077 Fifth Ave # Mer35, San Diego, CA 92103 — (619) 691-7587
  • 950 S Euclid Ave, San Diego, CA 92114-6201 — (619) 662-4100

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence A146408 (CA)

Record details

NPI number1306231840
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedApril 1, 2015
Last updated in NPPESJanuary 12, 2026
Certification dateJanuary 12, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2015 (11 years in practice)
Group practice Revive Pathway — 12 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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