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General NPI Number Information
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NPI Number | 1295802700
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Entity Type | Individual
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Provider Name | SAMUEL PENNEY SMITH M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 06/05/2023
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Provider Practice Location Address
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Address Line | 1127 WILSHIRE BLVD STE 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 | 213-482-9312
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Fax |
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Provider Business Mailing Address
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Address Line | 1127 WILSHIRE BLVD STE 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 | 310-864-0377
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A41530
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A4150
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License Number State | CA
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