Provider Demographics
NPI:1659383149
Name:KORN, TOMMY S (MD)
Entity Type:Individual
Prefix:
First Name:TOMMY
Middle Name:S
Last Name:KORN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3075 HEALTH CENTER DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2773
Mailing Address - Country:US
Mailing Address - Phone:858-939-5400
Mailing Address - Fax:858-939-5419
Practice Address - Street 1:3075 HEALTH CENTER DR
Practice Address - Street 2:SUITE 401
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2773
Practice Address - Country:US
Practice Address - Phone:858-939-5400
Practice Address - Fax:858-939-5419
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2020-10-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA64671207W00000X, 207WX0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A646710Medicaid
CA00A646710Medicaid
CAWA64671BMedicare ID - Type Unspecified