Provider Demographics
NPI:1184760969
Name:LEUNG, MAN KONG (MD)
Entity type:Individual
Prefix:DR
First Name:MAN KONG
Middle Name:
Last Name:LEUNG
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 1:4466 BLACK AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-6130
Mailing Address - Country:US
Mailing Address - Phone:925-600-8220
Mailing Address - Fax:925-600-8221
Practice Address - Street 1:4466 BLACK AVE STE A
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-6130
Practice Address - Country:US
Practice Address - Phone:925-600-8220
Practice Address - Fax:925-600-8221
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA749022084N0400X, 2084S0012X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI24135Medicare UPIN