MEDICARE: DR. RUSSELL EVAN LEONG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207KA0200X	Allergy Physician	G40648	CA

General Provider Information

NPI Number	:	1518961069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL EVAN LEONG M.D.

Provider Business Mailing Address
First Line	:	3838 CALIFORNIA ST
Second Line	:	ROOM 208
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-1522
Country	:	US
Telephone Number	:	415-221-0320
Fax Number	:	415-221-0329

Provider Business Practice Location Address
First Line	:	3838 CALIFORNIA ST
Second Line	:	RM 108
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-1504
Country	:	US
Telephone Number	:	415-221-0320
Fax Number	:	415-221-0329

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	07/17/2007

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