Provider Demographics
NPI:1619328481
Name:SMITH, LORELEY DENISE (MD)
Entity Type:Individual
Prefix:
First Name:LORELEY
Middle Name:DENISE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 E HILLSDALE BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-1296
Mailing Address - Country:US
Mailing Address - Phone:650-525-9030
Mailing Address - Fax:650-525-9040
Practice Address - Street 1:8 KORET WAY
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2218
Practice Address - Country:US
Practice Address - Phone:415-476-1921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016021475207W00000X
CAA169058207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology