1598840084 NPI number — MR. RICHARD K. SMITH CTRS,WOSH

Table of content: MR. RICHARD K. SMITH CTRS,WOSH (NPI 1598840084)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598840084 NPI number — MR. RICHARD K. SMITH CTRS,WOSH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
RICHARD
Provider Middle Name:
K.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CTRS,WOSH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598840084
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1139 HUNTINGTON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91030-4516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-478-3711
Provider Business Mailing Address Fax Number:
310-268-3279

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1139 HUNTINGTON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91030-4516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-478-3711
Provider Business Practice Location Address Fax Number:
310-268-3279
Provider Enumeration Date:
10/25/2006

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: 225800000X , with the licence number:  32086 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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