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General NPI Number Information
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NPI Number | 1861470783
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Entity Type | Individual
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Provider Name | KENT W SMALL MD
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Gender | Male
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Dates
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Enumeration Date | 01/03/2006
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Last Update Date | 04/12/2023
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Provider Practice Location Address
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Address Line | 411 N CENTRAL AVE STE 115
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City | GLENDALE
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State | CA
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Zip | 91203-3138
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Country | US
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Telephone | 818-552-5040
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Fax | 818-552-5044
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Provider Business Mailing Address
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Address Line | 501 NORTH ORANGE STREET SUITE 250
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City | GLENDALE
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State | CA
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Zip | 91203-1971
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Country | US
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Telephone | 818-552-5040
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Fax | 818-552-5044
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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 | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | A53173
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | A53173
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License Number State | CA
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