Provider Demographics
NPI:1265426951
Name:KANDA, LESLIE A (MD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:KANDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E OSBORN RD
Mailing Address - Street 2:#203
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2347
Mailing Address - Country:US
Mailing Address - Phone:602-263-8098
Mailing Address - Fax:602-234-8494
Practice Address - Street 1:300 E OSBORN RD
Practice Address - Street 2:#203
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2347
Practice Address - Country:US
Practice Address - Phone:602-263-8098
Practice Address - Fax:602-234-8494
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25702207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G60748Medicare UPIN
27655Medicare ID - Type Unspecified
AZ1063535284Medicare UPIN