Provider Demographics
NPI:1275637290
Name:KON, LEANNE MAYUMI (MD)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:MAYUMI
Last Name:KON
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 1:701 E 28TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2759
Mailing Address - Country:US
Mailing Address - Phone:562-426-5630
Mailing Address - Fax:562-492-9893
Practice Address - Street 1:701 E 28TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2759
Practice Address - Country:US
Practice Address - Phone:562-426-5630
Practice Address - Fax:562-492-9893
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90701207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ823342Medicaid
CAZZZ823342Medicaid
CAWA907010Medicare ID - Type UnspecifiedPPIN
CAI33651Medicare UPIN