MEDICARE: DR. KENNETH W WRIGHT M.D.

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	207W00000X	Ophthalmology Physician	G37720	CA

General Provider Information

NPI Number	:	1578650990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH W WRIGHT M.D.

Provider Business Mailing Address
First Line	:	520 S SAN VICENTE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-4616
Country	:	US
Telephone Number	:	310-652-6420
Fax Number	:	818-462-0991

Provider Business Practice Location Address
First Line	:	520 S SAN VICENTE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-4616
Country	:	US
Telephone Number	:	310-652-6420
Fax Number	:	818-462-0991

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	07/08/2007

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