Healthcare Provider Details

I. General information

NPI: 1760031363
Provider Name (Legal Business Name): SALEHI RETINA INSTITUTE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7812 EDINGER AVE STE 202
HUNTINGTON BEACH CA
92647-3727
US

IV. Provider business mailing address

75 ENTERPRISE STE 200
ALISO VIEJO CA
92656-2626
US

V. Phone/Fax

Practice location:
  • Phone: 714-901-2006
  • Fax:
Mailing address:
  • Phone: 949-688-6205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HANI SALEHI-HAD
Title or Position: CEO
Credential: MD
Phone: 310-562-4472