Provider Demographics
NPI:1295104750
Name:THE SHOE CLINIC, INC.
Entity type:Organization
Organization Name:THE SHOE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KARIM
Authorized Official - Middle Name:J
Authorized Official - Last Name:SALEHPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-559-1150
Mailing Address - Street 1:18050 CULVER DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2730
Mailing Address - Country:US
Mailing Address - Phone:949-559-1150
Mailing Address - Fax:949-559-1332
Practice Address - Street 1:18050 CULVER DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2730
Practice Address - Country:US
Practice Address - Phone:949-559-1150
Practice Address - Fax:949-559-1332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5377420001Medicare NSC