Healthcare Provider Details

I. General information

NPI: 1467732057
Provider Name (Legal Business Name): SALEM D.O., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2011
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18021 SKY PARK CIR STE G
IRVINE CA
92614-6569
US

IV. Provider business mailing address

9330 PECAN ST
CYPRESS CA
90630-2931
US

V. Phone/Fax

Practice location:
  • Phone: 949-260-0744
  • Fax: 949-260-0750
Mailing address:
  • Phone: 949-260-0744
  • Fax: 949-260-0750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A10607
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER SALEM
Title or Position: OWNER
Credential: D.O.
Phone: 949-260-0744