MEDICARE: DR. VIOLETTA KENIGSBERG D.D.S

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	1223P0300X	Periodontics	63288	CA
2	1223P0300X	Periodontics	057586	NY

General Provider Information

NPI Number	:	1538565510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIOLETTA KENIGSBERG D.D.S

Provider Business Mailing Address
First Line	:	8549 WILSHIRE BLVD STE 1159
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3104
Country	:	US
Telephone Number	:	424-279-4064
Fax Number	:

Provider Business Practice Location Address
First Line	:	8549 WILSHIRE BLVD STE 1159
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3104
Country	:	US
Telephone Number	:	424-279-4064
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2014
Last Update Date	:	10/19/2016

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