Healthcare Provider Details

I. General information

NPI: 1477650091
Provider Name (Legal Business Name): VALLEY SMILE MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18107 SHERMAN WAY SUITE 211
RESEDA CA
91335-4582
US

IV. Provider business mailing address

18107 SHERMAN WAY SUITE 211
RESEDA CA
91335-4582
US

V. Phone/Fax

Practice location:
  • Phone: 818-343-2775
  • Fax: 818-343-2764
Mailing address:
  • Phone: 818-343-2775
  • Fax: 818-343-2764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC29321
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA93050
License Number StateCA

VIII. Authorized Official

Name: DR. JIMMY J BAE
Title or Position: SECRETARY
Credential: D.C.
Phone: 818-343-2775