Provider Demographics
NPI:1962422063
Name:SMITH, MALCOLM IAIN (MD)
Entity type:Individual
Prefix:
First Name:MALCOLM
Middle Name:IAIN
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5632
Mailing Address - Country:US
Mailing Address - Phone:310-449-0939
Mailing Address - Fax:310-449-0977
Practice Address - Street 1:200 MEDICAL PLAZA
Practice Address - Street 2:#365,530,420,120
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095
Practice Address - Country:US
Practice Address - Phone:310-449-0939
Practice Address - Fax:310-449-0977
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2010-02-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG77343207RP1001X, 207R00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G773430Medicaid
CAF76133Medicare UPIN
CA00G773430Medicaid