MEDICARE: DRS GARY L WEINER & CHESTER N KAUFMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	B19018	CA
2	1223G0001X	General Practice Dentistry	B19914	CA

General Provider Information

NPI Number	:	1134118078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRS GARY L WEINER & CHESTER N KAUFMAN

Provider Business Mailing Address
First Line	:	3516 W IMPERIAL HWY
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90303-2222
Country	:	US
Telephone Number	:	310-677-9101
Fax Number	:	310-674-1517

Provider Business Practice Location Address
First Line	:	3516 W IMPERIAL HWY
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90303-2222
Country	:	US
Telephone Number	:	310-677-9101
Fax Number	:	310-674-1517

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	CHESTER W KAUFMAN
Credential	:	DDS
Telephone Number	:	310-677-9101

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	08/22/2020

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