Provider Demographics
NPI:1639378201
Name:SALMI, SASAN (MD)
Entity Type:Individual
Prefix:
First Name:SASAN
Middle Name:
Last Name:SALMI
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 1:1010 W LA VETA AVE
Mailing Address - Street 2:SUITE 610
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4300
Mailing Address - Country:US
Mailing Address - Phone:714-285-2311
Mailing Address - Fax:714-285-2319
Practice Address - Street 1:1010 W. LA VETA AVE.
Practice Address - Street 2:SUITE 610
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4304
Practice Address - Country:US
Practice Address - Phone:714-285-2311
Practice Address - Fax:714-285-2319
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA89408207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH69692Medicare UPIN