Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 35519 | CA |
NPI | 1356357636 |
---|---|
Provider Name | Dr. Leonard Lem |
First Address | Arcadia, CA 91007-7617 |
Second Address | Arcadia, CA 91007-7617 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B3551901 | DENTI-CAL PROVIDER ID (01) | CA |
F70594 | (02) | CA |