Healthcare Provider Details

I. General information

NPI: 1801713920
Provider Name (Legal Business Name): KENNETH LEM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6520 SWAINLAND RD
OAKLAND CA
94611-1800
US

IV. Provider business mailing address

6520 SWAINLAND RD
OAKLAND CA
94611-1800
US

V. Phone/Fax

Practice location:
  • Phone: 510-547-5030
  • Fax:
Mailing address:
  • Phone: 510-547-5030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number26625
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: