Provider Demographics
NPI:1427497122
Name:LEUNG, JASON G (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:G
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 1:955 BEISNER RD STE 1509
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3475
Mailing Address - Country:US
Mailing Address - Phone:847-631-5664
Mailing Address - Fax:847-631-5663
Practice Address - Street 1:955 BEISNER RD STE 1509
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3475
Practice Address - Country:US
Practice Address - Phone:847-631-5664
Practice Address - Fax:847-631-5663
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301105954208100000X
IL036-142584208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036142584-1Medicaid