Healthcare Provider Details

I. General information

NPI: 1417051079
Provider Name (Legal Business Name): JACOB SALEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18370 BURBANK BLVD SUITE 714
TARZANA CA
91356-2827
US

IV. Provider business mailing address

PO BOX 260994
ENCINO CA
91426-0994
US

V. Phone/Fax

Practice location:
  • Phone: 818-996-6100
  • Fax: 818-668-8323
Mailing address:
  • Phone: 818-996-6100
  • Fax: 818-668-8323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA40910
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: