Provider Demographics
NPI:1669544052
Name:LEONI, SEAN (MD)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:LEONI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:16661 VENTURA BLVD
Mailing Address - Street 2:SUITE 604
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1914
Mailing Address - Country:US
Mailing Address - Phone:888-254-6600
Mailing Address - Fax:818-788-8343
Practice Address - Street 1:26500 AGOURA RD
Practice Address - Street 2:SUITE 102-581
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1952
Practice Address - Country:US
Practice Address - Phone:888-254-6600
Practice Address - Fax:818-788-8343
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA53547207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA53547OtherSTATE LICENSE
CABL4263303OtherDEA CERTIFICATION
CAG25366Medicare UPIN
CAWA53547DMedicare ID - Type Unspecified