Provider Demographics
NPI:1639497209
Name:BENJAMIN Y LEONG MD INC
Entity Type:Organization
Organization Name:BENJAMIN Y LEONG MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:LEONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-275-6705
Mailing Address - Street 1:2083 COMPTON AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-7288
Mailing Address - Country:US
Mailing Address - Phone:951-468-8252
Mailing Address - Fax:
Practice Address - Street 1:4000 14TH ST STE 412
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4010
Practice Address - Country:US
Practice Address - Phone:951-468-8252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106797208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty