Healthcare Provider Details

I. General information

NPI: 1457388225
Provider Name (Legal Business Name): KEVIN S SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7525 LINDA VISTA RD STE C
SAN DIEGO CA
92111-5344
US

IV. Provider business mailing address

7525 LINDA VISTA RD STE C
SAN DIEGO CA
92111-5344
US

V. Phone/Fax

Practice location:
  • Phone: 619-398-2988
  • Fax: 619-398-2987
Mailing address:
  • Phone: 619-398-2988
  • Fax: 619-398-2987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG70647
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: