Active NPI
Jack Tyler Lyden, MD
- Psychiatry Physician
- Corona, CA
National Provider Identifier
1346980919
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 209112
- Practice address
- 4160 Temescal Canyon Rd
Corona, CA 92883-4625 - Phone
- (858) 279-1223
- NPI assigned
- Mar 31, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 209112 | CA | Primary |
Addresses
Primary practice location
4160 Temescal Canyon Rd
Corona, CA 92883-4625
Mailing address
4160 Temescal Canyon Rd
Corona, CA 92883-4625
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260610003884 | CA | Practitioner - Psychiatry | 7810469848 |
Care Compare profile
Medicare Care Compare- Specialty
- Psychiatry
- Education
- University of South Florida College of Medicine, 2022
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
4800 N Scottsdale Rd
Suite 2500
Scottsdale, AZ 85251-7630
490 Post St
San Francisco, CA 94102-1301
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209112 | CA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648684800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1778198400000",
"number": "1346980919",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4160 TEMESCAL CANYON RD",
"city": "CORONA",
"state": "CA",
"postal_code": "928834625"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4160 TEMESCAL CANYON RD",
"city": "CORONA",
"state": "CA",
"postal_code": "928834625",
"telephone_number": "858-279-1223"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LYDEN",
"first_name": "JACK",
"middle_name": "TYLER",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-03-31",
"last_updated": "2026-05-08",
"certification_date": "2026-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "209112",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.