Provider Demographics
NPI:1548319965
Name:ALKASSPOOLES, SALAM F (MD)
Entity type:Individual
Prefix:
First Name:SALAM
Middle Name:F
Last Name:ALKASSPOOLES
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 1:11633 SAN VICENTE BLVD STE 314
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6514
Mailing Address - Country:US
Mailing Address - Phone:310-207-0020
Mailing Address - Fax:310-207-0030
Practice Address - Street 1:11633 SAN VICENTE BLVD
Practice Address - Street 2:SUITE 314
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-6511
Practice Address - Country:US
Practice Address - Phone:310-207-0020
Practice Address - Fax:310-207-0030
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81802207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG81802OtherLICENSE
CA00G818020Medicaid
CAHB456ZMedicare PIN
CAG78467Medicare UPIN