MEDICARE: DR. JANET K. SMITH PH.D.

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	103TC0700X	Clinical Psychologist	12167	CA

General Provider Information

NPI Number	:	1699813337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANET K. SMITH PH.D.

Provider Business Mailing Address
First Line	:	10548 PUTNEY RD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-3330
Country	:	US
Telephone Number	:	310-839-5556
Fax Number	:

Provider Business Practice Location Address
First Line	:	12381 WILSHIRE BLVD
Second Line	:	SUITE 200
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1063
Country	:	US
Telephone Number	:	310-473-6169
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/08/2007

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