MEDICARE: TONY WONG LEUNG MD

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	207RN0300X	Nephrology Physician	07961R	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881693463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONY WONG LEUNG MD

Provider Business Mailing Address
First Line	:	PO BOX 6574
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70606-6574
Country	:	US
Telephone Number	:	337-497-0366
Fax Number	:	337-497-1367

Provider Business Practice Location Address
First Line	:	105 S RYAN ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-5950
Country	:	US
Telephone Number	:	337-497-0366
Fax Number	:	337-497-1367

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	12/05/2011

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