Provider Demographics
NPI:1306969308
Name:LEUNG, STEPHEN S (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:S
Last Name:LEUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SUI
Other - Middle Name:KEI
Other - Last Name:LEUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1045 E VALLEY BLVD
Mailing Address - Street 2:SUITE A210
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3661
Mailing Address - Country:US
Mailing Address - Phone:626-572-0012
Mailing Address - Fax:626-572-0799
Practice Address - Street 1:1045 E VALLEY BLVD
Practice Address - Street 2:SUITE A210
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3661
Practice Address - Country:US
Practice Address - Phone:626-572-0012
Practice Address - Fax:626-572-0799
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52914207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A529140Medicaid
CAA52914Medicare ID - Type Unspecified
CAF77394Medicare UPIN