Individual
DR. TIMOTHY EUN ORTLIP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2557 MOWRY AVE STE 30, FREMONT, CA 94538
(510) 248-1590
(510) 795-1459
Mailing address
2557 MOWRY AVE STE 30, FREMONT, CA 94538-1614
(510) 248-1590
(510) 795-1459
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
MD460908
PA
207YS0123X
Facial Plastic Surgery Physician
Primary
A155301
CA
207YS0123X
Facial Plastic Surgery Physician
MD460908
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/10/2012
Last updated
01/29/2019
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