Provider Demographics
NPI:1437326386
Name:LEONARD, SUSAN D (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:D
Last Name:LEONARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:DONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5767 W CENTURY BLVD
Mailing Address - Street 2:#400
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:310-206-8272
Mailing Address - Fax:310-791-2113
Practice Address - Street 1:200 MEDICAL PLZ
Practice Address - Street 2:SUITE 420
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-206-8272
Practice Address - Fax:310-791-2113
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105969207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1437326386Medicaid
CAEY784ZMedicare PIN