Provider Demographics
NPI:1205044583
Name:LEUNG DENTAL CORP
Entity Type:Organization
Organization Name:LEUNG DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-500-9200
Mailing Address - Street 1:111 E BROADWAY STE 202
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1044
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 E BROADWAY STE 202
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1044
Practice Address - Country:US
Practice Address - Phone:818-500-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental