Provider Demographics
NPI:1194826354
Name:LEUNG, HISAKO OHMOTO
Entity Type:Individual
Prefix:
First Name:HISAKO
Middle Name:OHMOTO
Last Name:LEUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HISAKO
Other - Middle Name:
Other - Last Name:OHMOTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4466 BLACK AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-6143
Mailing Address - Country:US
Mailing Address - Phone:925-600-8220
Mailing Address - Fax:925-600-8221
Practice Address - Street 1:4466 BLACK AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-6143
Practice Address - Country:US
Practice Address - Phone:925-600-8220
Practice Address - Fax:925-600-8221
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73077207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ32236ZMedicare ID - Type Unspecified
I 14944Medicare UPIN