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Tony Wong Leung
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NPI Number Detailed Information
Provider Information:
| Name: | Tony Wong Leung |
| Gender: | M |
| Provider License Number If Given: | 07961R |
NPI Information:
| NPI: | 1881693463 |
| Entity Type (Individual or Organization): |
1-ind |
| Enumeration Date: | 7/18/2005 |
| Last Update Date: | 12/5/2011 |
Provider Business Mailing Address:
| Address: | PO BOX 6574 Lake Charles, LA 70606 |
| Phone Number: | 3374970366 |
| Fax Number: | 3374971367 |
Provider Business Practice Location Address:
| Address: | 105 S RYAN ST Lake Charles, LA 70601 |
| Phone Number: | 3374970366 |
| Fax Number: | 3374971367 |
Provider Taxonomy:
| Primary: | 207RN0300X |
| Secondary (if any): | |
| State: | LA |
