# LA JOLLA FACIAL PLASTIC SURGERY INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033587589
- **Authorized official:** DR. VICTOR CHUNG M.D. (PRESIDENT/DIRECTOR)
- **Authorized official phone:** (858) 461-0383

## Contact information

- **Practice address:** 4765 CARMEL MOUNTAIN RD, SUITE 103, SAN DIEGO, CA 92130-6657
- **Practice address phone:** (858) 461-0383
- **Practice address fax:** (858) 430-2772
- **Mailing address:** 4765 CARMEL MOUNTAIN RD, SUITE 103, SAN DIEGO, CA 92130-6657
- **Mailing address phone:** (858) 461-0383
- **Mailing address fax:** (858) 430-2772

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207YX0905X | Otolaryngology/Facial Plastic Surgery Physician | A136426 | CA | Yes |

## Other

- **Enumeration date:** 09/14/2015
- **Last updated:** 02/21/2017