Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | G40648 | CA |
NPI | 1518961069 |
---|---|
Provider Name | Dr. Russell Evan Leong |
First Address | San Francisco, CA 94118-1522 |
Second Address | San Francisco, CA 94118-1504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2005 |
Last Update Date | 17/07/2007 |