MEDICARE: DR. RICHARD KEMPERT 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	207Q00000X	Family Medicine Physician	C37249	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	W13226B	OTHER	CA	MEDICARE GROUP NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	C37249	OTHER	CA	STATE LICENSE
3	ZZZ05180Z	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1861598500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD KEMPERT M.D.

Provider Business Mailing Address
First Line	:	PO BOX 3630
Second Line	:
City	:	DANA POINT
State	:	CA
Zip	:	92629-8630
Country	:	US
Telephone Number	:	949-496-4369
Fax Number	:	949-496-9365

Provider Business Practice Location Address
First Line	:	34052 LA PLZ
Second Line	:	SUITE 101
City	:	DANA POINT
State	:	CA
Zip	:	92629-2587
Country	:	US
Telephone Number	:	949-496-4369
Fax Number	:	949-496-9365

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

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	11/18/2011

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Directions to “ DR. RICHARD KEMPERT M.D.” Practice Location

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