Provider Demographics
NPI:1619036480
Name:LEONG, SAM B (PHD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:B
Last Name:LEONG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 SANCHEZ ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-3825
Mailing Address - Country:US
Mailing Address - Phone:415-550-6964
Mailing Address - Fax:
Practice Address - Street 1:1100 SANCHEZ ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-3825
Practice Address - Country:US
Practice Address - Phone:415-550-6964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2023-11-13
Deactivation Date:2023-11-11
Deactivation Code:
Reactivation Date:2023-11-13
Provider Licenses
StateLicense IDTaxonomies
CAPSY 14164103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical