Provider Demographics
NPI:1952330037
Name:LA JOLLA ORTHOPAEDIC SURGERY
Entity Type:Organization
Organization Name:LA JOLLA ORTHOPAEDIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF, LA JOLLA ORTHOPAEDIC SURGERY
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:TUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-643-5650
Mailing Address - Street 1:4510 EXECUTIVE DR
Mailing Address - Street 2:S125
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3021
Mailing Address - Country:US
Mailing Address - Phone:858-643-5650
Mailing Address - Fax:
Practice Address - Street 1:4510 EXECUTIVE DR
Practice Address - Street 2:S125
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3021
Practice Address - Country:US
Practice Address - Phone:858-643-5650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207T00000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ00696ZOtherBLUE SHIELD
CAZZZ00696ZOtherBLUE SHIELD