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General NPI Number Information
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NPI Number | 1033738851
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Entity Type | Individual
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Provider Name | CASEY JAKE SMITH
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Gender | Male
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Dates
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Enumeration Date | 04/11/2020
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Last Update Date | 09/19/2023
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Provider Practice Location Address
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Address Line | 2950 INTERNATIONAL BLVD
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City | OAKLAND
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State | CA
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Zip | 94601-2228
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Country | US
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Telephone | 505-862-2029
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Fax |
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Provider Business Mailing Address
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Address Line | 1545 DIVISADERO ST STE 306
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City | SAN FRANCISCO
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State | CA
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Zip | 94143-3400
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A189429
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License Number State | CA
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