Provider Demographics
NPI:1588311898
Name:LEUNG, KEVIN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:LEUNG
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10806 WILLOW CT STE 2
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-2428
Mailing Address - Country:US
Mailing Address - Phone:619-695-0688
Mailing Address - Fax:
Practice Address - Street 1:10806 WILLOW CT STE 2
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-2428
Practice Address - Country:US
Practice Address - Phone:619-695-0688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301823225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist