Basic Information
| Provider Information | |||||||||
| NPI: | 1811948789 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | JANELLEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | C340 MEDICAL SCIENCES I | ||||||||
| Address2: | DEPT OF DERMATOLOGY UC IRVINE | ||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926972400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9498245515 | ||||||||
| FaxNumber: | 9498247454 | ||||||||
| Practice Location | |||||||||
| Address1: | 15374 ALTON PKWY | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926182362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495850205 | ||||||||
| FaxNumber: | 9495859121 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 08/21/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | C50079 | CA | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 00C500790 | 05 | CA | MEDICAID |