Provider Demographics
NPI:1811920093
Name:WEPMAN, KENNETH JAY (DPM)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:JAY
Last Name:WEPMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3816 WOODRUFF AVE
Mailing Address - Street 2:SUITE #207
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-2147
Mailing Address - Country:US
Mailing Address - Phone:562-425-2113
Mailing Address - Fax:562-425-3044
Practice Address - Street 1:3816 WOODRUFF AVE
Practice Address - Street 2:SUITE #207
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-2147
Practice Address - Country:US
Practice Address - Phone:562-425-2113
Practice Address - Fax:562-425-3044
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3594213E00000X, 213EP1101X, 213ER0200X, 213ES0000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E35940Medicaid
CA330426137OtherFEDERAL TAX ID
CA0826880001OtherDME
CA8268800001Medicare NSC
CA1811920093Medicare NSC
CAU17335Medicare UPIN