Provider Demographics
NPI:1881253730
Name:LEONG, RUSSELL MING WEI (DO)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:MING WEI
Last Name:LEONG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3525 ENSIGN RD NE STE K
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5065
Mailing Address - Country:US
Mailing Address - Phone:360-413-8121
Mailing Address - Fax:360-413-8865
Practice Address - Street 1:3525 ENSIGN RD NE STE K
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5065
Practice Address - Country:US
Practice Address - Phone:360-413-8121
Practice Address - Fax:360-413-8865
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP61513037207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology