Healthcare Provider Details

I. General information

NPI: 1689889891
Provider Name (Legal Business Name): MCMILLAN PRIMARY CARE MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12131 CARSON ST
HAWAIIAN GARDENS CA
90716-1154
US

IV. Provider business mailing address

12131 CARSON ST
HAWAIIAN GARDENS CA
90716-1154
US

V. Phone/Fax

Practice location:
  • Phone: 562-809-0299
  • Fax: 562-809-0510
Mailing address:
  • Phone: 562-809-0299
  • Fax: 562-809-0510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberC34897
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberC34897
License Number StateCA

VIII. Authorized Official

Name: DR. LEMMON C MCMILLAN
Title or Position: OWNER
Credential: M.D.
Phone: 562-809-0299