Provider Demographics
NPI:1942505656
Name:LEUNG, GEORGE (LIC AC, ATC/L, PTA)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:LEUNG
Suffix:
Gender:M
Credentials:LIC AC, ATC/L, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1683 BEACON ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-4496
Mailing Address - Country:US
Mailing Address - Phone:617-447-5919
Mailing Address - Fax:
Practice Address - Street 1:1683 BEACON ST STE 1
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-4496
Practice Address - Country:US
Practice Address - Phone:617-447-5919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA238396171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist