Provider Demographics
NPI:1154573202
Name:TIMOTHY LEUNG, M.D., INC.
Entity type:Organization
Organization Name:TIMOTHY LEUNG, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-831-1317
Mailing Address - Street 1:905 SAN RAMON VALLEY BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-4035
Mailing Address - Country:US
Mailing Address - Phone:925-831-1317
Mailing Address - Fax:925-831-3609
Practice Address - Street 1:905 SAN RAMON VALLEY BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-4035
Practice Address - Country:US
Practice Address - Phone:925-831-1317
Practice Address - Fax:925-831-3609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA060992208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A609920Medicare PIN
CAH57643Medicare UPIN