Provider Demographics
NPI:1467886507
Name:KARL VON TIEHL, MD, INC.
Entity Type:Organization
Organization Name:KARL VON TIEHL, MD, INC.
Other - Org Name:BOWTIE ALLERGY SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:FRIEDRICH
Authorized Official - Last Name:VONTIEHL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-699-4949
Mailing Address - Street 1:375 HUNTINGTON DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2357
Mailing Address - Country:US
Mailing Address - Phone:626-460-6038
Mailing Address - Fax:877-886-6123
Practice Address - Street 1:375 HUNTINGTON DR
Practice Address - Street 2:SUITE C
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-2357
Practice Address - Country:US
Practice Address - Phone:626-460-6038
Practice Address - Fax:877-886-6123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-26
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95085261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty