Provider Demographics
NPI:1134118078
Name:DRS GARY L WEINER & CHESTER N KAUFMAN
Entity Type:Organization
Organization Name:DRS GARY L WEINER & CHESTER N KAUFMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:W
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-677-9101
Mailing Address - Street 1:3516 W IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90303-2222
Mailing Address - Country:US
Mailing Address - Phone:310-677-9101
Mailing Address - Fax:310-674-1517
Practice Address - Street 1:3516 W IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303-2222
Practice Address - Country:US
Practice Address - Phone:310-677-9101
Practice Address - Fax:310-674-1517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB199141223G0001X
CAB190181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty