Provider Demographics
NPI:1881132413
Name:SALIM, JASON (LAC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:SALIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 40TH ST # 302
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-2304
Mailing Address - Country:US
Mailing Address - Phone:510-599-3774
Mailing Address - Fax:
Practice Address - Street 1:644 40TH ST # 302
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-2304
Practice Address - Country:US
Practice Address - Phone:510-599-3774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17392171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist