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General NPI Number Information
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NPI Number | 1407376106
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Entity Type | Individual
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Provider Name | KYLE CLARK SMITH MD
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Gender | Male
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Dates
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Enumeration Date | 06/23/2017
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Last Update Date | 03/05/2026
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Provider Practice Location Address
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Address Line | 951 RESERVE DR STE 100
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City | ROSEVILLE
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State | CA
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Zip | 95678-1352
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Country | US
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Telephone | 916-800-0321
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Fax |
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Provider Business Mailing Address
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Address Line | 4720 SUNDANCE CT
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City | LOOMIS
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State | CA
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Zip | 95650-7963
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Country | US
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Telephone | 916-800-0321
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Fax | 916-975-9989
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A157640
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License Number State | CA
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