Provider Demographics
NPI:1437401031
Name:LEONG, MARY GRACE (RD, CDE)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:GRACE
Last Name:LEONG
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:GRACE
Other - Last Name:JUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2710 MIDDLEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-3404
Mailing Address - Country:US
Mailing Address - Phone:650-578-7141
Mailing Address - Fax:650-366-4732
Practice Address - Street 1:2710 MIDDLEFIELD RD
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-3404
Practice Address - Country:US
Practice Address - Phone:650-578-7141
Practice Address - Fax:650-366-4732
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
706151133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered