Provider Demographics
NPI:1114525698
Name:GOODMAN-SMITH, CHRISTOPHER RICHARD (LAC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:RICHARD
Last Name:GOODMAN-SMITH
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:415-600-3508
Mailing Address - Fax:415-369-1382
Practice Address - Street 1:2300 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2753
Practice Address - Country:US
Practice Address - Phone:415-600-3508
Practice Address - Fax:415-369-1382
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18951171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist