Provider Demographics
NPI:1447309471
Name:LEONG, KALMAN C (OD)
Entity type:Individual
Prefix:DR
First Name:KALMAN
Middle Name:C
Last Name:LEONG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:3000 ALAMO DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-6350
Mailing Address - Country:US
Mailing Address - Phone:707-447-9899
Mailing Address - Fax:707-447-5819
Practice Address - Street 1:3000 ALAMO DR
Practice Address - Street 2:SUITE 207
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-6350
Practice Address - Country:US
Practice Address - Phone:707-447-9899
Practice Address - Fax:707-447-5819
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA9034 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0090340Medicaid
CAU74988Medicare UPIN
CASD0090340Medicare ID - Type Unspecified