Basic Information
| Provider Information | |||||||||
| NPI: | 1396797049 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEUNG | ||||||||
| FirstName: | WINIFRED | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2320 BATH STREET | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931055322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9492638620 | ||||||||
| FaxNumber: | 9492631639 | ||||||||
| Practice Location | |||||||||
| Address1: | 2320 BATH STREET, SUITE 208 | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931055322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056827744 | ||||||||
| FaxNumber: | 8056823321 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 11/02/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 1377 | WI | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | A113766 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 390200000X | 50117 | WI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
ID Information
| ID | Type | State | Issuer | Description | 1396797049 | 05 | CA | MEDICAID | 1396797049 | 01 | CA | BLUE SHIELD | OTHER |