Provider Demographics
NPI:1548430069
Name:SAMUEL D LEUNG, S.C.
Entity Type:Organization
Organization Name:SAMUEL D LEUNG, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:312-326-1400
Mailing Address - Street 1:3 HILLCREST CT
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5757
Mailing Address - Country:US
Mailing Address - Phone:630-677-6267
Mailing Address - Fax:312-326-4188
Practice Address - Street 1:2142 S ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-1514
Practice Address - Country:US
Practice Address - Phone:312-326-1400
Practice Address - Fax:312-326-4188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062409261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD14648Medicare UPIN