Provider Demographics
NPI:1548563059
Name:LEONG, JEFFREY WC (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:WC
Last Name:LEONG
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 AHWAHNEE DR
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-1502
Mailing Address - Country:US
Mailing Address - Phone:415-279-3384
Mailing Address - Fax:
Practice Address - Street 1:830 AHWAHNEE DR
Practice Address - Street 2:
Practice Address - City:MILLBRAE
Practice Address - State:CA
Practice Address - Zip Code:94030-1502
Practice Address - Country:US
Practice Address - Phone:415-279-3384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA549181223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics