Healthcare Provider Details

I. General information

NPI: 1457939043
Provider Name (Legal Business Name): ASHKAN SALAMATIPOUR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
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: 949-200-1964
  • Fax: 949-209-4818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A23095
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number20A23095
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: