Provider Demographics
NPI:1306115175
Name:TONY W. LEUNG, M.D. LLC
Entity type:Organization
Organization Name:TONY W. LEUNG, M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:W
Authorized Official - Last Name:LEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-497-0366
Mailing Address - Street 1:P.O. BOX 6574
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70606
Mailing Address - Country:US
Mailing Address - Phone:337-497-0366
Mailing Address - Fax:337-497-1367
Practice Address - Street 1:105 DR. MICHAEL DEBAKEY DRIVE
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70606
Practice Address - Country:US
Practice Address - Phone:337-497-0366
Practice Address - Fax:337-497-1367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07961R207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1386812Medicaid
LA55816Medicare PIN
LAC-18347Medicare UPIN