MEDICARE: JACOB SALEH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	A40910	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417051079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB SALEH MD

Provider Business Mailing Address
First Line	:	PO BOX 260994
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91426-0994
Country	:	US
Telephone Number	:	818-996-6100
Fax Number	:	818-668-8323

Provider Business Practice Location Address
First Line	:	18370 BURBANK BLVD
Second Line	:	SUITE 714
City	:	TARZANA
State	:	CA
Zip	:	91356-2827
Country	:	US
Telephone Number	:	818-996-6100
Fax Number	:	818-668-8323

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	07/09/2007

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