Healthcare Provider Details

I. General information

NPI: 1831261155
Provider Name (Legal Business Name): GEOFFREY WON-CHEN LEUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9415 MISSION BLVD
RIVERSIDE CA
92509-2600
US

IV. Provider business mailing address

4065 COUNTY CIRCLE DR ROOM 309
RIVERSIDE CA
92503-3410
US

V. Phone/Fax

Practice location:
  • Phone: 951-360-8795
  • Fax: 951-360-8798
Mailing address:
  • Phone: 951-358-5222
  • Fax: 951-358-5235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA89812
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: