Provider Demographics
NPI:1881662690
Name:LEUNG, HENRY (DO)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:LEUNG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24801 ALICIA PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4654
Mailing Address - Country:US
Mailing Address - Phone:949-425-0321
Mailing Address - Fax:949-425-1204
Practice Address - Street 1:24801 ALICIA PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4654
Practice Address - Country:US
Practice Address - Phone:949-425-0321
Practice Address - Fax:949-425-1204
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8730207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABX412WMedicare UPIN
CABX412UMedicare UPIN
CABX412ZMedicare UPIN
CAZZZ07334ZMedicare PIN
CACE787AMedicare PIN
CABX412RMedicare UPIN
CACE787GMedicare PIN
CACE787BMedicare PIN
CABX412SMedicare UPIN
CACE787FMedicare PIN
CACE787BCMedicare PIN
CABX412YMedicare UPIN
CABX412XMedicare UPIN
CAI46110Medicare UPIN
CACE787EMedicare PIN