Healthcare Provider Details

I. General information

NPI: 1477174332
Provider Name (Legal Business Name): JOON YAU LEONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2020
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8614 E MILL PLAIN BLVD STE 201
VANCOUVER WA
98664-2058
US

IV. Provider business mailing address

PO BOX 31309
LOS ANGELES CA
90031-0309
US

V. Phone/Fax

Practice location:
  • Phone: 360-729-8580
  • Fax: 360-729-8599
Mailing address:
  • Phone: 626-457-6601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number70148654
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: