Provider Demographics
NPI:1336252642
Name:ASIN, LEONARD BRUCE (DPM)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:BRUCE
Last Name:ASIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 1712
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5801
Mailing Address - Country:US
Mailing Address - Phone:323-938-2068
Mailing Address - Fax:323-934-4111
Practice Address - Street 1:6200 WILSHIRE BLVD
Practice Address - Street 2:SUITE 1712
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5801
Practice Address - Country:US
Practice Address - Phone:323-938-2068
Practice Address - Fax:323-934-4111
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1224213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE1224Medicaid
E1224Medicare ID - Type Unspecified
CAT10838Medicare UPIN