Provider Demographics
NPI:1710920756
Name:LEMM, PATRICK J (DO)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:LEMM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15446 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-4319
Mailing Address - Country:US
Mailing Address - Phone:310-965-4811
Mailing Address - Fax:310-217-5318
Practice Address - Street 1:15446 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-4319
Practice Address - Country:US
Practice Address - Phone:310-965-4811
Practice Address - Fax:310-217-5318
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7716207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX77160Medicaid
W20A7716AMedicare ID - Type UnspecifiedMEDICARE PPIN
W20A7716BMedicare ID - Type UnspecifiedMEDICARE PPIN
CA00AX77160Medicaid