MEDICARE: SMITH & OBRIEN PSYCHIATRIC GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1124613849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMITH & OBRIEN PSYCHIATRIC GROUP INC

Provider Business Mailing Address
First Line	:	1127 WILSHIRE BLVD STE 1415
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-4005
Country	:	US
Telephone Number	:	800-578-1471
Fax Number	:

Provider Business Practice Location Address
First Line	:	1127 WILSHIRE BLVD STE 1415
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-4005
Country	:	US
Telephone Number	:	800-578-1471
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SAMUEL PENNEY SMITH
Credential	:	MD
Telephone Number	:	310-864-0377

Provider Enumeration Date	:	03/04/2021
Last Update Date	:	06/13/2023

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