Provider Demographics
NPI:1497834006
Name:LEONG, PEGGY (DMD)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:LEONG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 0760
Mailing Address - Street 2:707 PARNASSUS AV
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0760
Mailing Address - Country:US
Mailing Address - Phone:415-476-3028
Mailing Address - Fax:
Practice Address - Street 1:707 PARNASSUS AV
Practice Address - Street 2:SUITE D4000
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0760
Practice Address - Country:US
Practice Address - Phone:415-476-3028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA146261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice