Provider Demographics
NPI:1306018262
Name:LEUNG, WILFRED (MD)
Entity Type:Individual
Prefix:DR
First Name:WILFRED
Middle Name:
Last Name:LEUNG
Suffix:
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 1:6523 CALIFORNIA AVE SW STE 200
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-1833
Mailing Address - Country:US
Mailing Address - Phone:312-380-9455
Mailing Address - Fax:
Practice Address - Street 1:1011 10TH AVE SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1566
Practice Address - Country:US
Practice Address - Phone:360-349-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60348051207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2028403Medicaid
MS09338530Medicaid
MS09338530Medicaid