Healthcare Provider Details

I. General information

NPI: 1225046451
Provider Name (Legal Business Name): LYNN M SMOLIK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 LAUREL ST
SAN CARLOS CA
94070-3919
US

IV. Provider business mailing address

PO BOX 63
CAROGA LAKE NY
12032-0063
US

V. Phone/Fax

Practice location:
  • Phone: 650-322-2055
  • Fax: 650-322-0639
Mailing address:
  • Phone: 650-322-2055
  • Fax: 650-322-0639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberG528340
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG528340
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: