Provider Demographics
NPI:1952440562
Name:LEONG, ALLISON M (MD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:M
Last Name:LEONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2121 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5720
Mailing Address - Country:US
Mailing Address - Phone:310-264-1777
Mailing Address - Fax:310-264-1787
Practice Address - Street 1:2121 WILSHIRE BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5720
Practice Address - Country:US
Practice Address - Phone:310-264-1777
Practice Address - Fax:310-264-1787
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG48658207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG48658OtherMEDICAL LICENSE
WG48658AMedicare ID - Type Unspecified
C35842Medicare UPIN