Healthcare Provider Details

I. General information

NPI: 1205531381
Provider Name (Legal Business Name): LYDIA LEUNG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 N 1ST ST
SAN JOSE CA
95134-1513
US

IV. Provider business mailing address

973 UNIVERSITY AVE
LOS GATOS CA
95032-7636
US

V. Phone/Fax

Practice location:
  • Phone: 408-871-3400
  • Fax: 408-871-3401
Mailing address:
  • Phone: 408-871-3243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A23288
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: