NPI Code Detail JSON Logo

1154289379 NPI number — ELIJAH ISAIAH SMITH

NPI Number: 1154289379
Health Care Provider/Practitioner: ELIJAH ISAIAH SMITH

Information about “1154289379” NPI (ELIJAH ISAIAH SMITH) exists in 1154289379 in HTML format HTML  |  1154289379 in plain Text format TXT  |  1154289379 in PDF (Portable Document Format) PDF  |  1154289379 in an XML format XML  formats.

NPI Number : 1154289379 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1154289379",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SMITH",
    "FirstName": "ELIJAH",
    "MiddleName": "ISAIAH",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "533 NEWPORT AVE APT 1",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LONG BEACH",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90814-4763",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1274 CENTER COURT DR STE 211",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COVINA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "91724-3668",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "626-339-4999",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/15/2026",
    "LastUpdateDate": "01/15/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "106S00000X",
        "TaxonomyName": "Behavior Technician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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