Provider Demographics
NPI:1386848000
Name:LEONG, DARRYL (MD, MPH)
Entity Type:Individual
Prefix:
First Name:DARRYL
Middle Name:
Last Name:LEONG
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 CURTIS AVE
Mailing Address - Street 2:# B
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-2006
Mailing Address - Country:US
Mailing Address - Phone:310-386-0459
Mailing Address - Fax:
Practice Address - Street 1:2202 CURTIS AVE
Practice Address - Street 2:# B
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-2006
Practice Address - Country:US
Practice Address - Phone:310-386-0459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83975208000000X, 2083P0901X, 2083P0901X
AZ355262083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG83975OtherMEDICAL LICENSE
AZ35526OtherMEDICAL LICENSE
IA27611OtherMEDICAL LICENSE
HIMD-3739OtherMEDICAL LICENSE
CABL4849052OtherDEA