1124206495 NPI number — MR. TARICK KAMAL SMILEY M.D.

Table of content: MR. TARICK KAMAL SMILEY M.D. (NPI 1124206495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124206495 NPI number — MR. TARICK KAMAL SMILEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMILEY
Provider First Name:
TARICK
Provider Middle Name:
KAMAL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMUILI
Provider Other First Name:
TARICK
Provider Other Middle Name:
KAMAL
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1124206495
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9025 WILSHIRE BLVD STE #411
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEVERLY HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-275-1662
Provider Business Mailing Address Fax Number:
310-275-1652

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9025 WILSHIRE BLVD STE #411
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEVERLY HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-275-1662
Provider Business Practice Location Address Fax Number:
310-275-1652
Provider Enumeration Date:
02/08/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  A75774 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A75774 . This is a "UPIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".