Provider Demographics
NPI:1023207958
Name:SMITH, JILL K (MD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:K
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2730 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 660
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4743
Mailing Address - Country:US
Mailing Address - Phone:310-453-9100
Mailing Address - Fax:310-453-1155
Practice Address - Street 1:2730 WILSHIRE BLVD
Practice Address - Street 2:SUITE 660
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4743
Practice Address - Country:US
Practice Address - Phone:310-453-9100
Practice Address - Fax:310-453-1155
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2008-10-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA722202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry