Healthcare Provider Details

I. General information

NPI: 1679152730
Provider Name (Legal Business Name): MATTHEW LEONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 N ROBERTSON BLVD STE 500
LOS ANGELES CA
90048-3100
US

IV. Provider business mailing address

700 N SAN VICENTE BLVD STE G530
WEST HOLLYWOOD CA
90069-5060
US

V. Phone/Fax

Practice location:
  • Phone: 310-248-6241
  • Fax:
Mailing address:
  • Phone: 310-423-4612
  • Fax: 310-423-0311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberA193975
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: