Healthcare Provider Details

I. General information

NPI: 1366519266
Provider Name (Legal Business Name): KENNETH LEONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HILLMONT AVE STE 401
VENTURA CA
93003-1651
US

IV. Provider business mailing address

2911 48TH ST W
BRADENTON FL
34209-6131
US

V. Phone/Fax

Practice location:
  • Phone: 805-648-9830
  • Fax:
Mailing address:
  • Phone: 818-454-6359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG81070
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberME128087
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: