Provider Demographics
NPI:1770182990
Name:LEUNG, RICKY T
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:T
Last Name:LEUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N DOS ROBLES PL
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-1221
Mailing Address - Country:US
Mailing Address - Phone:626-863-9575
Mailing Address - Fax:
Practice Address - Street 1:1000 N DOS ROBLES PL
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-1221
Practice Address - Country:US
Practice Address - Phone:626-863-9575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant