Provider Demographics
NPI:1356357636
Name:LEM, LEONARD (MD, DDS)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:
Last Name:LEM
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 W DUARTE RD
Mailing Address - Street 2:SUITE # 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:SUITE # 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA355191223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3551901OtherDENTI-CAL PROVIDER ID
CAF70594Medicare UPIN