=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275950115
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL LEMOR M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2014
-----------------------------------------------------
Last Update Date | 09/17/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4036 WHITTIER BLVD STE 202
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-262-3333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4036 WHITTIER BLVD STE 202
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90023-2561
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-262-3333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207WX0120X
-----------------------------------------------------
Taxonomy Name | Cornea and External Diseases Specialist Physician
-----------------------------------------------------
License Number | A156391
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | A156391
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | MD.MD.60820872
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------