Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 41869 | CA |
Y | 213EG0000X | General Practice | 41869 | CA |
NPI | 1003946658 |
---|---|
Provider Name | Dr. Thomas Owen Smith |
First Address | Laguna Hills, CA 92653-4342 |
Second Address | Laguna Hills, CA 92653-4342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 20/03/2017 |