Basic Information
| Provider Information | |||||||||
| NPI: | 1285700328 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SALAMA | ||||||||
| FirstName: | SAMEH | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34509 9TH AVE S STE 204 | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980038708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538355510 | ||||||||
| FaxNumber: | 3604787241 | ||||||||
| Practice Location | |||||||||
| Address1: | 34509 9TH AVE S STE 204 | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980038708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538355510 | ||||||||
| FaxNumber: | 3604787241 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2006 | ||||||||
| LastUpdateDate: | 12/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD00030094 | WA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1100742 | 05 | WA | MEDICAID | 1057237 | 05 | WA | MEDICAID |