Healthcare Provider Details

I. General information

NPI: 1659383149
Provider Name (Legal Business Name): TOMMY S. KORN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 HEALTH CENTER DR SUITE 401
SAN DIEGO CA
92123-2773
US

IV. Provider business mailing address

3075 HEALTH CENTER DR SUITE 401
SAN DIEGO CA
92123-2773
US

V. Phone/Fax

Practice location:
  • Phone: 858-939-5400
  • Fax: 858-939-5419
Mailing address:
  • Phone: 858-939-5400
  • Fax: 858-939-5419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA64671
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License NumberA64671
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: