Provider Demographics
NPI:1013198456
Name:INLAND EAR, HEAD & NECK CLINIC
Entity Type:Organization
Organization Name:INLAND EAR, HEAD & NECK CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:TK
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PHD
Authorized Official - Phone:951-352-7920
Mailing Address - Street 1:3975 JACKSON ST
Mailing Address - Street 2:STE. 202
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3901
Mailing Address - Country:US
Mailing Address - Phone:951-352-7920
Mailing Address - Fax:951-352-7908
Practice Address - Street 1:3975 JACKSON ST
Practice Address - Street 2:STE. 202
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3901
Practice Address - Country:US
Practice Address - Phone:951-352-7920
Practice Address - Fax:951-352-7908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52096207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ32000ZMedicare PIN