=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790168474
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AUDREY SAN LEUNG MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2015
-----------------------------------------------------
Last Update Date | 07/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 325 9TH AVE
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98104-2420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-520-5000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 925 NORTH GRAND BLVD ROOM B719
-----------------------------------------------------
City | ST LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-652-4100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | R-10441
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | MD61087441
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2081P0004X
-----------------------------------------------------
Taxonomy Name | Spinal Cord Injury Medicine Physician
-----------------------------------------------------
License Number | ML60951455
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 2081P0004X
-----------------------------------------------------
Taxonomy Name | Spinal Cord Injury Medicine Physician
-----------------------------------------------------
License Number | MD61087441
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------