Provider Demographics
NPI:1053850453
Name:DR LEUNG DDS INC
Entity Type:Organization
Organization Name:DR LEUNG DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHI
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-243-3677
Mailing Address - Street 1:411 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2081
Mailing Address - Country:US
Mailing Address - Phone:818-243-3677
Mailing Address - Fax:818-240-8998
Practice Address - Street 1:411 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2081
Practice Address - Country:US
Practice Address - Phone:818-243-3677
Practice Address - Fax:818-240-8998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43361122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty