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General NPI Number Information
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NPI Number | 1164427001
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Entity Type | Individual
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Provider Name | BRYANT C. LEUNG III MD
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Gender | Male
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 07/23/2019
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Provider Practice Location Address
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Address Line | 4354 LATHAM ST STE 100
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City | RIVERSIDE
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State | CA
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Zip | 92501-1777
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Country | US
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Telephone | 951-683-0650
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Fax | 951-774-4610
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Provider Business Mailing Address
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Address Line | 4354 LATHAM ST STE 100
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City | RIVERSIDE
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State | CA
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Zip | 92501-1777
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Country | US
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Telephone | 951-683-0650
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Fax | 951-774-4612
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | A69385
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | A69385
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License Number State | CA
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