Provider Demographics
NPI:1417179060
Name:LEUNG, GRACE
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:LEUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:CX
Other - Last Name:LEUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:1375 65TH ST
Mailing Address - Street 2:#15
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-5649
Mailing Address - Country:US
Mailing Address - Phone:347-370-4072
Mailing Address - Fax:
Practice Address - Street 1:1375 65TH ST
Practice Address - Street 2:#15
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-5649
Practice Address - Country:US
Practice Address - Phone:347-370-4072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003362171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist