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General NPI Number Information
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NPI Number | 1144567447
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Entity Type | Organization
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Legal Business Name | SAMUEL P SMITH MD . INC
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Dates
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Enumeration Date | 01/08/2013
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Last Update Date | 01/08/2013
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Provider Practice Location Address
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Address Line | 1127 WILSHIRE BLVD SUITE 1415
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City | LOS ANGELES
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State | CA
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Zip | 90017-3901
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Country | US
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Telephone | 213-482-9311
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Fax | 213-250-3092
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Provider Business Mailing Address
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Address Line | 1127 WILSHIRE BLVD SUITE 1415
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City | LOS ANGELES
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State | CA
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Zip | 90017-4005
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Country | US
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Telephone | 213-482-9311
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Fax | 213-250-3092
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Authorized Official
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Title or Position | PRESIDENT
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Name | SAMUEL PENNEY SMITH
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Credential | MD
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Telephone | 213-482-9311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A41530
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License Number State | CA
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