Healthcare Provider Details

I. General information

NPI: 1881733947
Provider Name (Legal Business Name): HOWARD GARY KAUFMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 BELLFLOWER BLVD STE 108
LONG BEACH CA
90815-4013
US

IV. Provider business mailing address

1777 BELLFLOWER BLVD STE 108
LONG BEACH CA
90815-4013
US

V. Phone/Fax

Practice location:
  • Phone: 562-597-5700
  • Fax: 562-494-3434
Mailing address:
  • Phone: 562-597-5700
  • Fax: 562-494-3434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number28943
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number28943
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: