Provider Demographics
NPI:1164427001
Name:LEUNG, BRYANT C III (MD)
Entity Type:Individual
Prefix:
First Name:BRYANT
Middle Name:C
Last Name:LEUNG
Suffix:III
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 1:4354 LATHAM ST
Mailing Address - Street 2:STE 100
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-1777
Mailing Address - Country:US
Mailing Address - Phone:951-683-0650
Mailing Address - Fax:951-774-4612
Practice Address - Street 1:4354 LATHAM ST
Practice Address - Street 2:STE 100
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-1777
Practice Address - Country:US
Practice Address - Phone:951-683-0650
Practice Address - Fax:951-774-4610
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69385208VP0000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA250012347OtherRAILROAD MEDICARE
CA00A693850Medicare PIN
CA250012347OtherRAILROAD MEDICARE