Provider Demographics
NPI:1447403472
Name:SMITH, GRANT A
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750-41 SUTTER STREET
Mailing Address - Street 2:
Mailing Address - City:SAN FRANSCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3248
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:41 SUTTER ST
Practice Address - Street 2:#1750
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-4905
Practice Address - Country:US
Practice Address - Phone:510-532-2686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC530171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist