Healthcare Provider Details

I. General information

NPI: 1811948789
Provider Name (Legal Business Name): JANELLEN SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15374 ALTON PKWY
IRVINE CA
92618-2362
US

IV. Provider business mailing address

C340 MEDICAL SCIENCES I DEPT OF DERMATOLOGY UC IRVINE
IRVINE CA
92697-2400
US

V. Phone/Fax

Practice location:
  • Phone: 949-585-0205
  • Fax: 949-585-9121
Mailing address:
  • Phone: 949-824-5515
  • Fax: 949-824-7454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberC50079
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: