Provider Demographics
NPI:1558407643
Name:LEUNG, JOHN WING PUI (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WING PUI
Last Name:LEUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:WING PUI
Other - Last Name:LEUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 35891
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5891
Mailing Address - Country:US
Mailing Address - Phone:702-395-1070
Mailing Address - Fax:702-395-1071
Practice Address - Street 1:8440 W LAKE MEAD BLVD STE 202
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-7648
Practice Address - Country:US
Practice Address - Phone:702-395-1070
Practice Address - Fax:702-395-1071
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21943207L00000X, 207LC0200X, 207LP2900X
CAG89183207L00000X
NV13979207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN09553Medicaid
SCG15215Medicare UPIN