Provider Demographics
NPI:1871604686
Name:LEUNG, RAYMOND WP (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:WP
Last Name:LEUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16702 VALLEY VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-5824
Mailing Address - Country:US
Mailing Address - Phone:714-367-5360
Mailing Address - Fax:714-635-5428
Practice Address - Street 1:1717 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-4345
Practice Address - Country:US
Practice Address - Phone:714-635-2642
Practice Address - Fax:714-635-8547
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48262208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0084970Medicaid
CACI430YMedicare PIN
CAGR0084970Medicaid
CAAY663XMedicare PIN
CAWG48262KMedicare PIN
CAWG48262HMedicare PIN
CAOOG482623Medicare PIN
CAWG48262EMedicare PIN
CAWG48262JMedicare PIN
CACI430XMedicare PIN
CACI430ZMedicare PIN