Healthcare Provider Details

I. General information

NPI: 1467158527
Provider Name (Legal Business Name): JOSEPH LEEM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 LOVELL CT
CONCORD CA
94520-4303
US

IV. Provider business mailing address

3511 SCHOOL ST
LAFAYETTE CA
94549-4547
US

V. Phone/Fax

Practice location:
  • Phone: 201-213-8744
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number110699
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: