Healthcare Provider Details

I. General information

NPI: 1477408961
Provider Name (Legal Business Name): KEMEH MEDICAL PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22855 LAKE FOREST DR
LAKE FOREST CA
92630-1656
US

IV. Provider business mailing address

22855 LAKE FOREST DR
LAKE FOREST CA
92630-1656
US

V. Phone/Fax

Practice location:
  • Phone: 315-710-1274
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: HAMMAM G KEMEH
Title or Position: OWNER
Credential:
Phone: 949-779-4123