Healthcare Provider Details

I. General information

NPI: 1407879596
Provider Name (Legal Business Name): DAVID RICHARD WYNDHAMSMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 06/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 WILSON TER
GLENDALE CA
91206-4007
US

IV. Provider business mailing address

PO BOX 60790
PASADENA CA
91116-6790
US

V. Phone/Fax

Practice location:
  • Phone: 818-409-8000
  • Fax: 818-546-5632
Mailing address:
  • Phone: 626-204-6747
  • Fax: 626-396-0851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG72018
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: