Basic Information
Provider Information
NPI: 1790947075
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEUNG
FirstName: YIU TAK
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD PHD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 211 S. 9TH STREET
Address2: SUITE 600
City: PHILADELPHIA
State: PA
PostalCode: 19107
CountryCode: US
TelephoneNumber: 2159558430
FaxNumber: 2159235828
Practice Location
Address1: 3401 N BROAD ST
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191405103
CountryCode: US
TelephoneNumber: 2157074000
FaxNumber: 2157074034
Other Information
ProviderEnumerationDate: 06/27/2008
LastUpdateDate: 10/29/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RR0500XMD450507PAY Allopathic & Osteopathic PhysiciansInternal MedicineRheumatology

No ID Information.


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