Healthcare Provider Details

I. General information

NPI: 1235450958
Provider Name (Legal Business Name): TJOSON TJOA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

200 S MANCHESTER AVE
ORANGE CA
92868-3217
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-8888
  • Fax: 714-456-8888
Mailing address:
  • Phone: 714-456-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number262971
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA119742
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: