MEDICARE: WESTON WRIGHT MEDICAL CORPORATION

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	:	1811045206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTON WRIGHT MEDICAL CORPORATION

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	:	310-652-6463

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	:	310-652-6463

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KENNETH WESTON WRIGHT
Credential	:	M.D.
Telephone Number	:	310-652-6420

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	08/22/2020

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