Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | E3594 | CA |
N | 222Z00000X | Podiatrist | E3594 | CA |
Y | 213EP1101X | Primary Podiatric Medicine | E3594 | CA |
N | 111NR0200X | Radiology | E3594 | CA |
N | 213ER0200X | Radiology | E3594 | CA |
N | 2081S0010X | Sports Medicine | E3594 | CA |
N | 213ES0000X | Sports Medicine | E3594 | CA |
N | 213ES0131X | Foot Surgery | E3594 | CA |
NPI | 1811920093 |
---|---|
Provider Name | Kenneth Jay Wepman |
First Address | Long Beach, CA 90808-2147 |
Second Address | Long Beach, CA 90808-2147 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2006 |
Last Update Date | 10/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E35940 | (05) | CA |
0826880001 | DME (01) | CA |
330426137 | FEDERAL TAX ID (01) | CA |
U17335 | (02) | CA |