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General NPI Number Information
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NPI Number | 1639490121
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Entity Type | Individual
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Provider Name | KRISTEN DIANE SMITH M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/18/2010
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 34800 BOB WILSON DR
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City | SAN DIEGO
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State | CA
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Zip | 92134-0140
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Country | US
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Telephone | 619-532-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 8901 ROCKVILLE PIKE
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City | BETHESDA
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State | MD
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Zip | 20889-5600
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Country | US
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Telephone | 301-295-4000
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 150939
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 143969
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License Number State | MT
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