Healthcare Provider Details

I. General information

NPI: 1164221685
Provider Name (Legal Business Name): ASHKAN SALAMATIPOUR, DO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2025
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NEWPORT CENTER DR STE 602A
NEWPORT BEACH CA
92660-7629
US

IV. Provider business mailing address

3334 E COAST HWY # 436
CORONA DEL MAR CA
92625-2328
US

V. Phone/Fax

Practice location:
  • Phone: 949-200-1964
  • Fax: 949-209-4818
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ASHKAN SALAMATIPOUR
Title or Position: CHIEF MEDICAL OFFICER
Credential: DO
Phone: 949-200-1964