Provider Demographics
NPI:1285854778
Name:SALKINDER, GUSTAV (MD)
Entity type:Individual
Prefix:
First Name:GUSTAV
Middle Name:
Last Name:SALKINDER
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 1:16250 VENTURA BLVD
Mailing Address - Street 2:STE 255
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2289
Mailing Address - Country:US
Mailing Address - Phone:323-655-1605
Mailing Address - Fax:323-655-1621
Practice Address - Street 1:7855 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5344
Practice Address - Country:US
Practice Address - Phone:323-655-1605
Practice Address - Fax:323-655-1621
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG073167174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF 254771Medicare UPIN