MEDICARE: LA JOLLA ORTHOPAEDIC SURGERY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician		CA
2	207T00000X	Neurological Surgery Physician		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ00696Z	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1952330037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA JOLLA ORTHOPAEDIC SURGERY

Provider Business Mailing Address
First Line	:	4510 EXECUTIVE DR
Second Line	:	S125
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-3021
Country	:	US
Telephone Number	:	858-643-5650
Fax Number	:

Provider Business Practice Location Address
First Line	:	4510 EXECUTIVE DR
Second Line	:	S125
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-3021
Country	:	US
Telephone Number	:	858-643-5650
Fax Number	:

Authorized Official
Title or Position	:	CHIEF, LA JOLLA ORTHOPAEDIC SURGERY
Name	:	DR. HOWARD TUNG
Credential	:	M.D.
Telephone Number	:	858-643-5650

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	07/21/2022

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Directions to “LA JOLLA ORTHOPAEDIC SURGERY ” Practice Location

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