MEDICARE: KENNETH JAY WEPMAN DPM

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	213E00000X	Podiatrist	E3594	CA
2	213EP1101X	Primary Podiatric Medicine Podiatrist	E3594	CA
3	213ER0200X	Radiology Podiatrist	E3594	CA
4	213ES0000X	Sports Medicine Podiatrist	E3594	CA
5	213ES0131X	Foot Surgery Podiatrist	E3594	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	330426137	OTHER	CA	FEDERAL TAX ID
3	0826880001	OTHER	CA	DME

General Provider Information

NPI Number	:	1811920093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH JAY WEPMAN DPM

Provider Business Mailing Address
First Line	:	3816 WOODRUFF AVE
Second Line	:	SUITE #207
City	:	LONG BEACH
State	:	CA
Zip	:	90808-2147
Country	:	US
Telephone Number	:	562-425-2113
Fax Number	:	562-425-3044

Provider Business Practice Location Address
First Line	:	3816 WOODRUFF AVE
Second Line	:	SUITE #207
City	:	LONG BEACH
State	:	CA
Zip	:	90808-2147
Country	:	US
Telephone Number	:	562-425-2113
Fax Number	:	562-425-3044

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

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	07/18/2024

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