Provider Demographics
NPI:1124206495
Name:SMILEY, TARICK KAMAL (MD)
Entity Type:Individual
Prefix:MR
First Name:TARICK
Middle Name:KAMAL
Last Name:SMILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:TARICK
Other - Middle Name:KAMAL
Other - Last Name:SMUILI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9025 WILSHIRE BLVD STE #411
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211
Mailing Address - Country:US
Mailing Address - Phone:310-275-1662
Mailing Address - Fax:310-275-1652
Practice Address - Street 1:9025 WILSHIRE BLVD STE #411
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211
Practice Address - Country:US
Practice Address - Phone:310-275-1662
Practice Address - Fax:310-275-1652
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-08
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA75774261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA75774OtherUPIN