Provider Demographics
NPI:1275191819
Name:LEUNG, WAI CHOW
Entity Type:Individual
Prefix:MR
First Name:WAI
Middle Name:CHOW
Last Name:LEUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:STEVE
Other - Middle Name:
Other - Last Name:LEUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1050 BORREGAS AVE SPC 108
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94089-1646
Mailing Address - Country:US
Mailing Address - Phone:408-896-0491
Mailing Address - Fax:
Practice Address - Street 1:250 BON AIR RD UNIT B
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1702
Practice Address - Country:US
Practice Address - Phone:415-473-3096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA755007163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health