Healthcare Provider Details

I. General information

NPI: 1295297463
Provider Name (Legal Business Name): CEDARS FAMILY MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2019
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 TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER EDWARD SALEM
Title or Position: CEO
Credential: DO
Phone: 949-260-0744