Provider Demographics
NPI:1326244534
Name:LEONARD LEM, M.D., D.D.S., INC.
Entity Type:Organization
Organization Name:LEONARD LEM, M.D., D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL AND MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-821-9633
Mailing Address - Street 1:650 W DUARTE RD
Mailing Address - Street 2:#300
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7617
Mailing Address - Country:US
Mailing Address - Phone:626-821-9633
Mailing Address - Fax:626-821-9697
Practice Address - Street 1:650 W DUARTE RD
Practice Address - Street 2:#300
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7617
Practice Address - Country:US
Practice Address - Phone:626-821-9633
Practice Address - Fax:626-821-9697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA355191223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3551901OtherSTATE LICENSE NUMBER
CAF70594Medicare UPIN