Provider Demographics
NPI:1386886190
Name:SALAH, MOIN SALAHUDDIN (MD)
Entity type:Individual
Prefix:
First Name:MOIN
Middle Name:SALAHUDDIN
Last Name:SALAH
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 1:2382 CRENSHAW BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501
Mailing Address - Country:US
Mailing Address - Phone:310-618-9200
Mailing Address - Fax:
Practice Address - Street 1:2382 CRENSHAW BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-3333
Practice Address - Country:US
Practice Address - Phone:310-618-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-26
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA108939207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine