Healthcare Provider Details

I. General information

NPI: 1124206495
Provider Name (Legal Business Name): TARICK KAMAL SMILEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TARICK KAMAL SMUILI M.D.

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9025 WILSHIRE BLVD STE #411
BEVERLY HILLS CA
90211
US

IV. Provider business mailing address

9025 WILSHIRE BLVD STE #411
BEVERLY HILLS CA
90211
US

V. Phone/Fax

Practice location:
  • Phone: 310-275-1662
  • Fax: 310-275-1652
Mailing address:
  • Phone: 310-275-1662
  • Fax: 310-275-1652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA75774
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: