Basic Information
| Provider Information | |||||||||
| NPI: | 1639497209 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BENJAMIN Y LEONG MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2083 COMPTON AVE STE 103 | ||||||||
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| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928817288 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9514688252 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4000 14TH ST STE 412 | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925014010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9514688252 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2010 | ||||||||
| LastUpdateDate: | 12/19/2013 | ||||||||
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| AuthorizedOfficialLastName: | LEONG | ||||||||
| AuthorizedOfficialFirstName: | BENJAMIN | ||||||||
| AuthorizedOfficialMiddleName: | Y | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9142756705 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | A106797 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.