Healthcare Provider Details

I. General information

NPI: 1154959021
Provider Name (Legal Business Name): JOSHUA LEU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3635 VISTA AVE
SAINT LOUIS MO
63110-2539
US

IV. Provider business mailing address

6534 E WATERTON AVE
ORANGE CA
92867-2464
US

V. Phone/Fax

Practice location:
  • Phone: 314-268-7133
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA184027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: