Healthcare Provider Details

I. General information

NPI: 1770363301
Provider Name (Legal Business Name): THOMAS LEONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

879 W 190TH ST STE 720
GARDENA CA
90248-4205
US

IV. Provider business mailing address

2648 E WORKMAN AVE STE 3001
WEST COVINA CA
91791-1604
US

V. Phone/Fax

Practice location:
  • Phone: 310-217-7312
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: