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General NPI Number Information
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NPI Number | 1376892778
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Entity Type | Organization
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Legal Business Name | MAAN SALLOUM MD PLLC
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Dates
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Enumeration Date | 08/31/2012
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Last Update Date | 08/23/2018
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Provider Practice Location Address
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Address Line | 1370 116TH AVE NE SUITE 100
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City | BELLEVUE
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State | WA
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Zip | 98004
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Country | US
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Telephone | 425-462-6100
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Fax | 425-635-0742
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Provider Business Mailing Address
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Address Line | 8215 64TH STREET CT W
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98467-3911
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Country | US
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Telephone | 253-380-6551
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Fax |
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | DR. MAAN SALLOUM
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Credential | MD
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Telephone | 253-318-7015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD00016874
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License Number State | WA
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