Provider Demographics
NPI:1699138008
Name:SALLOWM, YAMIN (MD)
Entity type:Individual
Prefix:
First Name:YAMIN
Middle Name:
Last Name:SALLOWM
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69780 STELLAR DR STE A
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-2954
Mailing Address - Country:US
Mailing Address - Phone:760-424-3380
Mailing Address - Fax:
Practice Address - Street 1:69780 STELLAR DR STE A
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-2954
Practice Address - Country:US
Practice Address - Phone:800-653-6568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA194792208VP0014X, 2084P2900X
MI4301502982208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine