Healthcare Provider Details

I. General information

NPI: 1437326386
Provider Name (Legal Business Name): SUSAN D. LEONARD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN DONG MD

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PLZ SUITE 420
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

5767 W CENTURY BLVD #400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-8272
  • Fax: 310-791-2113
Mailing address:
  • Phone: 310-206-8272
  • Fax: 310-791-2113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberA105969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: