Healthcare Provider Details

I. General information

NPI: 1396978409
Provider Name (Legal Business Name): MICHAEL S. LEONG, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15195 NATIONAL AVE SUITE # 205
LOS GATOS CA
95032-2631
US

IV. Provider business mailing address

PO BOX 578
PACIFIC GROVE CA
93950-0578
US

V. Phone/Fax

Practice location:
  • Phone: 408-358-9917
  • Fax: 408-358-9927
Mailing address:
  • Phone: 408-358-9917
  • Fax: 408-358-9927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA53960
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA53960
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL S. LEONG
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 408-358-9917