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General NPI Number Information
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NPI Number | 1467732057
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Entity Type | Organization
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Legal Business Name | SALEM D.O., INC.
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Dates
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Enumeration Date | 08/26/2011
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Last Update Date | 11/10/2020
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Provider Practice Location Address
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Address Line | 18021 SKY PARK CIR STE G
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City | IRVINE
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State | CA
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Zip | 92614-6569
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Country | US
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Telephone | 949-260-0744
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Fax | 949-260-0750
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Provider Business Mailing Address
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Address Line | 9330 PECAN ST
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City | CYPRESS
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State | CA
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Zip | 90630-2931
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Country | US
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Telephone | 949-260-0744
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Fax | 949-260-0750
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTOPHER SALEM
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Credential | D.O.
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Telephone | 949-260-0744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A10607
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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