Provider Demographics
NPI:1659820579
Name:DENTISTCA, DENTAL PRACTICE OF JOHN K. LEUNG, D.D.S., P.C.
Entity Type:Organization
Organization Name:DENTISTCA, DENTAL PRACTICE OF JOHN K. LEUNG, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-343-2120
Mailing Address - Street 1:500 PRIMROSE RD
Mailing Address - Street 2:#3
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-4088
Mailing Address - Country:US
Mailing Address - Phone:650-343-2120
Mailing Address - Fax:
Practice Address - Street 1:500 PRIMROSE RD
Practice Address - Street 2:#3
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4088
Practice Address - Country:US
Practice Address - Phone:650-343-2120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34629122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty