Provider Demographics
NPI:1396066676
Name:JASMINE K. LEONG M.D. PROFESSIONAL CORP.
Entity type:Organization
Organization Name:JASMINE K. LEONG M.D. PROFESSIONAL CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-817-5000
Mailing Address - Street 1:1280 CORONA POINTE CT
Mailing Address - Street 2:#118
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-1770
Mailing Address - Country:US
Mailing Address - Phone:951-817-5000
Mailing Address - Fax:951-817-5002
Practice Address - Street 1:1280 CORONA POINTE CT
Practice Address - Street 2:#118
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-1770
Practice Address - Country:US
Practice Address - Phone:951-817-5000
Practice Address - Fax:951-817-5002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG673040207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G673040Medicaid
CAE96811Medicare UPIN
CA00G673040Medicare PIN