Provider Demographics
NPI:1851307102
Name:LEONG, KIAN V (MD)
Entity Type:Individual
Prefix:
First Name:KIAN
Middle Name:V
Last Name:LEONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26726
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755-0726
Mailing Address - Country:US
Mailing Address - Phone:512-407-8686
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:1301 W. 38TH ST. #205
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1011
Practice Address - Country:US
Practice Address - Phone:512-324-1864
Practice Address - Fax:512-419-9016
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7346207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105582405Medicaid
TX105582402Medicaid
TX105582403Medicaid
TX105582404Medicaid
TX105582403Medicaid
TXTXB155559Medicare PIN
TXTXB155558Medicare PIN
TXP01158697Medicare PIN
TX110162589Medicare PIN
TX87J461Medicare PIN