Healthcare Provider Details

I. General information

NPI: 1821144429
Provider Name (Legal Business Name): TED LEEM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 12/01/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9449 IMPERIAL HWY SUITE 128
DOWNEY CA
90242-2814
US

IV. Provider business mailing address

9449 IMPERIAL HWY SUITE 128
DOWNEY CA
90242-2814
US

V. Phone/Fax

Practice location:
  • Phone: 562-657-4900
  • Fax:
Mailing address:
  • Phone: 562-657-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTL-1327
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberDR-49903
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA107632
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: