DR. CORY CLEMENT D.P.M., NPI 1154736684 — LOS ANGELES (CA)

NPI 1154736684

5+ Years Experience Individual

DR. CORY CLEMENT D.P.M.

06/23/2014
PROVIDER ENUMERATION DATE
05/20/2019
LAST UPDATE DATE
1154736684
NPI NUMBER

About DR. CORY CLEMENT

Sole proprietor? Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor.

DR. CORY CLEMENT is a provider established in LOS ANGELES, CA. The NPI number of DR. CORY CLEMENT is 1154736684 and was assigned on 06/23/2014. The practitioners primary taxonomy code is: 213ES0103X with license number: E5365 CA .

Mailing address

  • City: LOS ANGELES
  • State: CA
  • Postal code: 900154202
  • Phone: 3236694346
  • Fax: 3236351891
  • Address: 950 S GRAND AVE

Primary Practice Address

  • Region : LOS ANGELES, CA
  • NPI : 1154736684
  • Phone : 3237804510
  • Fax : 3237806132
  • Postalcode : 900221602
  • Address : 4816 E 3RD ST

Provider taxonomy - Podiatrist

  • Taxonomy code: 213ES0103X
  • License number: E5365
  • License state: CA

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Contacts:

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  • DR. CORY CLEMENT D.P.M.
  • Address : 4816 E 3RD ST
  • Region : LOS ANGELES, CA
  • NPI : 1154736684
  • Phone : 3237804510
  • Fax : 3237806132
  • Postalcode : 900221602

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address4816 E 3RD ST
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameLOS ANGELES
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameCA
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code900221602
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number3237804510
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number3237806132
The fax number associated with the location address of the provider being identified.
NPI1154736684
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1213ES0103X
Provider Enumeration Date06/23/2014
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated05/20/2019
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)DR. CORY CLEMENT
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address950 S GRAND AVE
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City NameLOS ANGELES
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameCA
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code900154202
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number3236694346
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number3236351891
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Healthcare Provider Taxonomy Code #1213ES0103X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Podiatrist
Provider License Number 1E5365
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1CA
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Provider Gender CodeM
  • M - male
  • F - female
Is sole proprietorY
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

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