Provider Demographics
NPI:1518223981
Name:ORTLIP, TIMOTHY EUN (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:EUN
Last Name:ORTLIP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2557 MOWRY AVE STE 30
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1614
Mailing Address - Country:US
Mailing Address - Phone:510-248-1590
Mailing Address - Fax:510-795-1459
Practice Address - Street 1:2557 MOWRY AVE STE 30
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538
Practice Address - Country:US
Practice Address - Phone:510-248-1590
Practice Address - Fax:510-795-1459
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD460908207Y00000X, 207YS0123X
390200000X
CAA155301207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program