Provider Demographics
NPI:1851474217
Name:TOTAL VASCULAR SURGERY INC
Entity Type:Organization
Organization Name:TOTAL VASCULAR SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:JUNG
Authorized Official - Middle Name:J
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:916-784-1836
Mailing Address - Street 1:5 MEDICAL PLAZA DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2867
Mailing Address - Country:US
Mailing Address - Phone:916-784-1836
Mailing Address - Fax:916-784-1880
Practice Address - Street 1:5 MEDICAL PLAZA DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2867
Practice Address - Country:US
Practice Address - Phone:916-784-1836
Practice Address - Fax:916-784-1880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-21
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A87672086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX87670Medicaid
CA00AX87670Medicaid
CAZZZ04954ZMedicare PIN