Provider Demographics
NPI:1003992173
Name:LEUNG, JIM C (MD)
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:C
Last Name:LEUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JIM
Other - Middle Name:C
Other - Last Name:LEUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7171 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2902
Mailing Address - Country:US
Mailing Address - Phone:954-721-4300
Mailing Address - Fax:954-721-8080
Practice Address - Street 1:7171 N UNIVERSITY DR
Practice Address - Street 2:SUITE 203
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2902
Practice Address - Country:US
Practice Address - Phone:954-721-4300
Practice Address - Fax:954-721-8080
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97201207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
90871OtherBC/BS FLORIDA
305160OtherAVMED
AC378ZMedicare PIN