Provider Demographics
NPI:1891867602
Name:LEONG, THOMAS SC (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:SC
Last Name:LEONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:SINPOCHIN
Other - Last Name:LEONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10631 TANK HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-4340
Mailing Address - Country:US
Mailing Address - Phone:209-473-2920
Mailing Address - Fax:
Practice Address - Street 1:10631 TANK HOUSE DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-4340
Practice Address - Country:US
Practice Address - Phone:209-473-2920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35638207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A356380Medicaid
A27859Medicare UPIN
00A356380Medicare ID - Type Unspecified