MEDICARE: DR. KEVIN MATTHEW SMITH MD

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	208000000X	Pediatrics Physician	G59269	CA

General Provider Information

NPI Number	:	1700314952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN MATTHEW SMITH MD

Provider Business Mailing Address
First Line	:	715 CAMINO CATALINA
Second Line	:
City	:	SOLANA BEACH
State	:	CA
Zip	:	92075-1631
Country	:	US
Telephone Number	:	502-235-6366
Fax Number	:

Provider Business Practice Location Address
First Line	:	715 CAMINO CATALINA
Second Line	:
City	:	SOLANA BEACH
State	:	CA
Zip	:	92075-1631
Country	:	US
Telephone Number	:	502-235-6366
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2017
Last Update Date	:	07/21/2022

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