Healthcare Provider Details

I. General information

NPI: 1134159148
Provider Name (Legal Business Name): DOHENY EYE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 SAN PABLO ST SUITE 4000
LOS ANGELES CA
90033-4500
US

IV. Provider business mailing address

1450 SAN PABLO ST SUITE 3700
LOS ANGELES CA
90033-4500
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-7155
  • Fax: 323-442-7158
Mailing address:
  • Phone: 323-442-7155
  • Fax: 323-442-7158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RONALD E SMITH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 323-442-6425