Provider Demographics
NPI:1629092143
Name:LEMLEY, KEVIN V (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:V
Last Name:LEMLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4000
Mailing Address - Street 2:
Mailing Address - City:SUNRIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97707-4000
Mailing Address - Country:US
Mailing Address - Phone:626-379-2638
Mailing Address - Fax:
Practice Address - Street 1:19 MUIR COURT
Practice Address - Street 2:
Practice Address - City:SUNRIVER
Practice Address - State:OR
Practice Address - Zip Code:97707-4000
Practice Address - Country:US
Practice Address - Phone:626-379-2638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG821592080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G400140Medicaid
CA00G400140Medicaid
CAWG40014Medicare ID - Type Unspecified