Provider Demographics
NPI:1396797049
Name:LEUNG, WINIFRED K (MD)
Entity type:Individual
Prefix:
First Name:WINIFRED
Middle Name:K
Last Name:LEUNG
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 1:2320 BATH STREET
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-5322
Mailing Address - Country:US
Mailing Address - Phone:949-263-8620
Mailing Address - Fax:949-263-1639
Practice Address - Street 1:2320 BATH STREET, SUITE 208
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-5322
Practice Address - Country:US
Practice Address - Phone:805-682-7744
Practice Address - Fax:805-682-3321
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13772085R0202X
CAA1137662085R0202X
WI50117390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1396797049Medicaid
CA1396797049OtherBLUE SHIELD
CADP714YMedicare PIN
CADP714XMedicare PIN
CA1396797049Medicaid