Provider Demographics
NPI:1215913876
Name:TUOMINEN, KORY LEE (MD)
Entity type:Individual
Prefix:
First Name:KORY
Middle Name:LEE
Last Name:TUOMINEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26671 ALISO CREEK RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-4809
Mailing Address - Country:US
Mailing Address - Phone:949-556-3304
Mailing Address - Fax:949-625-5289
Practice Address - Street 1:26671 ALISO CREEK RD
Practice Address - Street 2:SUITE 304
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-4809
Practice Address - Country:US
Practice Address - Phone:949-556-3304
Practice Address - Fax:949-625-5289
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN41754207Q00000X
CAA103333207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
47D39TUOtherBCBS
151339OtherUCARE
MH9101025601OtherPREFERRED ONE
080173452OtherRAILROAD MEDICARE
0113155OtherMEDICA
MN279521300Medicaid
CAEB744YMedicare PIN
47D39TUOtherBCBS
080173452OtherRAILROAD MEDICARE