Provider Demographics
NPI:1124273313
Name:SALEM, CHRISTOPHER E (DO)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:E
Last Name:SALEM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9330 PECAN ST
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-2931
Mailing Address - Country:US
Mailing Address - Phone:949-260-0744
Mailing Address - Fax:949-260-0750
Practice Address - Street 1:18021 SKY PARK CIR STE G
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6569
Practice Address - Country:US
Practice Address - Phone:949-260-0744
Practice Address - Fax:949-260-0744
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10607207P00000X, 207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACK717WMedicare PIN