Provider Demographics
NPI:1265812374
Name:LEUANG, TONY
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:LEUANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82165 DOCTOR CARREON BLVD APT 33B1
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-4800
Mailing Address - Country:US
Mailing Address - Phone:404-543-4714
Mailing Address - Fax:
Practice Address - Street 1:82165 DOCTOR CARREON BLVD APT 33B1
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-4800
Practice Address - Country:US
Practice Address - Phone:404-543-4714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52512363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical