Provider Demographics
NPI:1902992001
Name:SMITH, HERMAN LEWIS (MD)
Entity Type:Individual
Prefix:
First Name:HERMAN
Middle Name:LEWIS
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:H
Other - Middle Name:LEWIS
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:14350 E WHITTIER BLVD 325
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-2151
Mailing Address - Country:US
Mailing Address - Phone:562-696-1145
Mailing Address - Fax:562-696-3772
Practice Address - Street 1:14350 E WHITTIER BLVD 325
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-2151
Practice Address - Country:US
Practice Address - Phone:562-696-1145
Practice Address - Fax:562-696-3772
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA16282208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A16282Medicaid
A16282Medicare ID - Type Unspecified
A81671Medicare UPIN