Provider Demographics
NPI:1568531986
Name:FAYNGOR, LEONARD NAUM (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:NAUM
Last Name:FAYNGOR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9939 EAST GARVEY AVE
Mailing Address - Street 2:SUITE # D
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733
Mailing Address - Country:US
Mailing Address - Phone:626-444-2227
Mailing Address - Fax:
Practice Address - Street 1:9939 EAST GARVEY AVE
Practice Address - Street 2:SUITE # D
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733
Practice Address - Country:US
Practice Address - Phone:626-444-2227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB032300-01Medicaid