Provider Demographics
NPI:1366510943
Name:LEUNG, TIMOTHY (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:LEUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA060992208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH57643Medicare UPIN
CA00A609920Medicare ID - Type Unspecified