Provider Demographics
NPI:1811948789
Name:SMITH, JANELLEN (MD)
Entity type:Individual
Prefix:DR
First Name:JANELLEN
Middle Name:
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:C340 MEDICAL SCIENCES I
Mailing Address - Street 2:DEPT OF DERMATOLOGY UC IRVINE
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92697-2400
Mailing Address - Country:US
Mailing Address - Phone:949-824-5515
Mailing Address - Fax:949-824-7454
Practice Address - Street 1:15374 ALTON PKWY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2362
Practice Address - Country:US
Practice Address - Phone:949-585-0205
Practice Address - Fax:949-585-9121
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50079207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C500790Medicaid
CA00C500790Medicaid
CA00C500790Medicare PIN