MEDICARE: VALLEY SMILE MEDICAL CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A93050	CA
2	111N00000X	Chiropractor	DC29321	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1346351517	OTHER	CA	NPI

General Provider Information

NPI Number	:	1477650091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY SMILE MEDICAL CENTER, INC

Provider Business Mailing Address
First Line	:	18107 SHERMAN WAY
Second Line	:	SUITE 211
City	:	RESEDA
State	:	CA
Zip	:	91335-4582
Country	:	US
Telephone Number	:	818-343-2775
Fax Number	:	818-343-2764

Provider Business Practice Location Address
First Line	:	18107 SHERMAN WAY
Second Line	:	SUITE 211
City	:	RESEDA
State	:	CA
Zip	:	91335-4582
Country	:	US
Telephone Number	:	818-343-2775
Fax Number	:	818-343-2764

Authorized Official
Title or Position	:	SECRETARY
Name	:	DR. JIMMY J BAE
Credential	:	D.C.
Telephone Number	:	818-343-2775

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	09/11/2025

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