Healthcare Provider Details

I. General information

NPI: 1043356728
Provider Name (Legal Business Name): SABINA WIEDERKEHR DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 12/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 TWEEDY BLVD
SOUTH GATE CA
90280-6304
US

IV. Provider business mailing address

1736 11TH ST
MANHATTAN BEACH CA
90266-6210
US

V. Phone/Fax

Practice location:
  • Phone: 323-564-2444
  • Fax: 323-249-7565
Mailing address:
  • Phone:
  • Fax: 323-249-7565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number53889
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: