Healthcare Provider Details

I. General information

NPI: 1275950115
Provider Name (Legal Business Name): DANIEL LEMOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4036 WHITTIER BLVD STE 202
LOS ANGELES CA
90023
US

IV. Provider business mailing address

4036 WHITTIER BLVD STE 202
LOS ANGELES CA
90023-2561
US

V. Phone/Fax

Practice location:
  • Phone: 323-262-3333
  • Fax:
Mailing address:
  • Phone: 323-262-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA156391
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD.MD.60820872
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License NumberA156391
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: