# KOLSTAD PLASTIC SURGERY, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kolstad Facial Plastic Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588952188
- **Authorized official:** DR. CHRISTOPHER KOLSTAD MD (OWNER)
- **Authorized official phone:** (858) 859-2563

## Contact information

- **Practice address:** 4180 LA JOLLA VILLAGE DR, SUITE 455, LA JOLLA, CA 92037
- **Practice address phone:** (858) 859-2563
- **Practice address fax:** (858) 999-3541
- **Mailing address:** 4180 LA JOLLA VILLAGE DR, SUITE 455, LA JOLLA, CA 92037
- **Mailing address phone:** (858) 859-2563
- **Mailing address fax:** (858) 999-3541

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207YS0123X | Facial Plastic Surgery Physician | A100294 | CA | — |
| 207YX0905X | Otolaryngology/Facial Plastic Surgery Physician | — | NULL | — |
| 207YX0905X | Otolaryngology/Facial Plastic Surgery Physician | — | — | — |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/16/2011
- **Last updated:** 08/21/2025