=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023019411
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LOUIS SMOLENSKY MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11539 HAWTHORNE BLVD 6TH FLOOR
-----------------------------------------------------
City | HAWTHORNE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90250-2325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-875-5370
-----------------------------------------------------
Fax | 310-531-2084
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11539 HAWTHORNE BLVD 6TH FLOOR
-----------------------------------------------------
City | HAWTHORNE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90250-2325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-875-5370
-----------------------------------------------------
Fax | 310-531-2084
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | G26610
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------