Provider Demographics
NPI:1477650091
Name:VALLEY SMILE MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:VALLEY SMILE MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-343-2775
Mailing Address - Street 1:18107 SHERMAN WAY
Mailing Address - Street 2:SUITE 211
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4582
Mailing Address - Country:US
Mailing Address - Phone:818-343-2775
Mailing Address - Fax:818-343-2764
Practice Address - Street 1:18107 SHERMAN WAY
Practice Address - Street 2:SUITE 211
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4582
Practice Address - Country:US
Practice Address - Phone:818-343-2775
Practice Address - Fax:818-343-2764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29321111N00000X
CAA93050207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1346351517OtherNPI
CAU99789Medicare UPIN