Provider Demographics
NPI:1265432967
Name:LEI, CALVIN K (MD)
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:K
Last Name:LEI
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 1:5565 W LAS POSITAS BLVD STE 260
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-5807
Mailing Address - Country:US
Mailing Address - Phone:925-416-5470
Mailing Address - Fax:
Practice Address - Street 1:5565 W LAS POSITAS BLVD STE 260
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-5807
Practice Address - Country:US
Practice Address - Phone:925-416-5470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54048207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A540480Medicaid
G44704Medicare UPIN
CA00A540480Medicare ID - Type Unspecified