Provider Demographics
NPI:1417051079
Name:SALEH, JACOB (MD)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:SALEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 260994
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91426-0994
Mailing Address - Country:US
Mailing Address - Phone:818-996-6100
Mailing Address - Fax:818-668-8323
Practice Address - Street 1:18370 BURBANK BLVD
Practice Address - Street 2:SUITE 714
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2827
Practice Address - Country:US
Practice Address - Phone:818-996-6100
Practice Address - Fax:818-668-8323
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40910208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A409100Medicaid
CA5883117Medicaid
CA5883117Medicaid
CA00A409100Medicaid