Provider Demographics
NPI:1679086524
Name:CHUNG, LEON (DDS)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:
Last Name:CHUNG
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 1:1491 CEDARWOOD LN STE C
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-6126
Mailing Address - Country:US
Mailing Address - Phone:925-918-6500
Mailing Address - Fax:925-918-4750
Practice Address - Street 1:1491 CEDARWOOD LN STE C
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-6126
Practice Address - Country:US
Practice Address - Phone:925-918-6500
Practice Address - Fax:925-918-4750
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1021391223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice