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General NPI Number Information
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NPI Number | 1609309368
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Entity Type | Individual
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Provider Name | MICHELLE LEONG D.O.
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Gender | Female
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Dates
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Enumeration Date | 04/09/2017
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Last Update Date | 05/08/2024
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Provider Practice Location Address
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Address Line | 5601 DE SOTO AVE
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City | WOODLAND HILLS
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State | CA
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Zip | 91367-6701
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Country | US
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Telephone | 833-574-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 2430 CASA GRANDE ST
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City | PASADENA
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State | CA
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Zip | 91104-3407
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Country | US
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Telephone |
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Fax |
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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 | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 036160713
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License Number State | IL
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