Provider Demographics
NPI:1194619403
Name:KELLY K. LEONG, DMD, INC.
Entity type:Organization
Organization Name:KELLY K. LEONG, DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:KIMIKO
Authorized Official - Last Name:LEONG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:415-297-8642
Mailing Address - Street 1:2645 OCEAN AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1646
Mailing Address - Country:US
Mailing Address - Phone:707-340-3886
Mailing Address - Fax:
Practice Address - Street 1:2645 OCEAN AVE STE 203
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1646
Practice Address - Country:US
Practice Address - Phone:415-741-3636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty