Provider Demographics
NPI:1932257268
Name:LUNDE, OTTAR VIKER (MD)
Entity Type:Individual
Prefix:DR
First Name:OTTAR
Middle Name:VIKER
Last Name:LUNDE
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 1:3221 BANCROFT ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-4729
Mailing Address - Country:US
Mailing Address - Phone:619-925-5146
Mailing Address - Fax:
Practice Address - Street 1:330 LEWIS STREET
Practice Address - Street 2:MAIL CODE 8201-A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-8201
Practice Address - Country:US
Practice Address - Phone:619-471-9250
Practice Address - Fax:619-471-9255
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97573207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine