Provider Demographics
NPI:1831176171
Name:KWEI, LEON S (MD)
Entity type:Individual
Prefix:DR
First Name:LEON
Middle Name:S
Last Name:KWEI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3200 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1227
Mailing Address - Country:US
Mailing Address - Phone:304-388-4172
Mailing Address - Fax:304-388-4155
Practice Address - Street 1:3200 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1227
Practice Address - Country:US
Practice Address - Phone:304-388-4172
Practice Address - Fax:304-388-4155
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV150962080P0204X
WV15906207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001723889OtherWV BCBS
WV0073469000Medicaid
WV1057343OtherWV DWC
WV001718040OtherBLUE CROSS BLUE SHIELD
WV1053519OtherWVDWC
WV001718040OtherBLUE CROSS BLUE SHIELD
WV1057343OtherWV DWC
WVE76846Medicare UPIN
WV0073469000Medicaid
WV930122365Medicare PIN
WV930100108Medicare PIN
WV0679562Medicare PIN