Provider Demographics
NPI:1083627798
Name:LEONG, JASMINE KIMGOKE (MD)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:KIMGOKE
Last Name:LEONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:KIMGOKE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1901 TOWN AND COUNTRY DR STE 104
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-3611
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1820 FULLERTON AVE STE 115
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-3160
Practice Address - Country:US
Practice Address - Phone:951-817-5000
Practice Address - Fax:951-817-5002
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG67304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine