Healthcare Provider Details

I. General information

NPI: 1720572506
Provider Name (Legal Business Name): LEON HSUEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13755 CICERO AVE
CRESTWOOD IL
60418-1824
US

IV. Provider business mailing address

10833 LE CONTE AVE
LOS ANGELES CA
90095-1688
US

V. Phone/Fax

Practice location:
  • Phone: 708-385-2400
  • Fax: 708-385-7840
Mailing address:
  • Phone: 310-825-8373
  • Fax: 310-825-3632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLP04438
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036164290
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: