Provider Demographics
NPI:1689637654
Name:LEUNG, YATWAH (MD)
Entity Type:Individual
Prefix:DR
First Name:YATWAH
Middle Name:
Last Name:LEUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:LEUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 5109
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-5109
Mailing Address - Country:US
Mailing Address - Phone:336-887-1545
Mailing Address - Fax:336-887-1339
Practice Address - Street 1:218 GATEWOOD AVE
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4820
Practice Address - Country:US
Practice Address - Phone:336-889-9555
Practice Address - Fax:336-887-1339
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2000005182085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891263VMedicaid
NC00Y304P01OtherMEDICARE PTAN
NC00Y304P01OtherMEDICARE PTAN
NC891263VMedicaid
NCBL4533611OtherDEA