MEDICARE: BENTE KAISER M.D., INC

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	207V00000X	Obstetrics & Gynecology Physician	A103372	CA

General Provider Information

NPI Number	:	1154622322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENTE KAISER M.D., INC

Provider Business Mailing Address
First Line	:	4407 S MAIN ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-2731
Country	:	US
Telephone Number	:	323-233-0249
Fax Number	:

Provider Business Practice Location Address
First Line	:	4407 S MAIN ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-2731
Country	:	US
Telephone Number	:	323-233-0249
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BENTE L.N. KAISER
Credential	:	M.D.
Telephone Number	:	323-233-0249

Provider Enumeration Date	:	11/04/2010
Last Update Date	:	11/04/2010

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