Provider Demographics
NPI:1376572743
Name:LEUNG, DENNIS (OD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
Last Name:LEUNG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 W DUARTE RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7332
Mailing Address - Country:US
Mailing Address - Phone:626-446-2028
Mailing Address - Fax:626-288-8326
Practice Address - Street 1:655 W DUARTE RD # B
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7332
Practice Address - Country:US
Practice Address - Phone:626-446-2028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8179152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0081790Medicaid
CA8179OtherOPTOMETRY LICENSE
CA8179OtherOPTOMETRY LICENSE