Jonathan Daniel Salk, M.D.

Primary specialty

Psychosomatic Medicine PhysicianTaxonomy code 2084P0015X

License

G 62404 Issued in CA

Practice address

11980 San Vicente Blvd
Suite 810
Los Angeles, CA 90049-5012

Phone

(310) 824-0258

Fax

(310) 824-7818

NPI assigned

May 25, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508077041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11980 SAN VICENTE BLVD",
            "address_2": "SUITE 810",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900495012",
            "telephone_number": "310-824-0258",
            "fax_number": "310-824-7818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11980 SAN VICENTE BLVD",
            "address_2": "SUITE 810",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900495012",
            "telephone_number": "310-824-0258",
            "fax_number": "310-824-7818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SALK",
        "first_name": "JONATHAN",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0015X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychosomatic Medicine",
            "state": "CA",
            "license": "G 62404",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kent W. Salisbury, M.D.
• Richard M Salit, M.D.
• Ololade Temitope Saliu, MD
• Olufemi Yekini Saliu, M.D.
• Benjamin Roswell Salk, LMFT
• Konstantin Salkinder, MD
• David E Sall, B.A.
• Tamer Sallam, MD
• Colin James Sallee
• Sierra M Sallee, DNP, PNP-AC, BSN

• Psychosomatic Medicine Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Psychosomatic Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.