Healthcare Provider Details

I. General information

NPI: 1215460670
Provider Name (Legal Business Name): ANDREW KENT SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 HEALTH SCIENCES RD
IRVINE CA
92697-2307
US

IV. Provider business mailing address

12 CORAZON DEL ORO
RANCHO SANTA MARGARITA CA
92688-2688
US

V. Phone/Fax

Practice location:
  • Phone: 949-824-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA158630
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberA158630
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: