Provider Demographics
NPI:1023019411
Name:SMOLENSKY, LOUIS (MD)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:
Last Name:SMOLENSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11539 HAWTHORNE BLVD
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2325
Mailing Address - Country:US
Mailing Address - Phone:310-875-5370
Mailing Address - Fax:310-531-2084
Practice Address - Street 1:11539 HAWTHORNE BLVD
Practice Address - Street 2:6TH FLOOR
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2325
Practice Address - Country:US
Practice Address - Phone:310-875-5370
Practice Address - Fax:310-531-2084
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG26610208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G266100Medicaid
CA00G266100Medicaid
A43045Medicare UPIN