Provider Demographics
NPI:1881693463
Name:LEUNG, TONY WONG (MD)
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:WONG
Last Name:LEUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:WONG
Other - Last Name:AW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 6574
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70606-6574
Mailing Address - Country:US
Mailing Address - Phone:337-497-0366
Mailing Address - Fax:337-497-1367
Practice Address - Street 1:105 S RYAN ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5950
Practice Address - Country:US
Practice Address - Phone:337-497-0366
Practice Address - Fax:337-497-1367
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07961R207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1386812Medicaid
LA55816Medicare ID - Type Unspecified
C18347Medicare UPIN