Provider Demographics
NPI:1205941994
Name:LEUNG, ALEX C N (PHD)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:C N
Last Name:LEUNG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:PROF
Other - First Name:ALEX
Other - Middle Name:C N
Other - Last Name:LEUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:511 KING DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2985
Mailing Address - Country:US
Mailing Address - Phone:650-692-6648
Mailing Address - Fax:650-754-9645
Practice Address - Street 1:341 WESTLAKE CTR
Practice Address - Street 2:SUITE 320
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-1441
Practice Address - Country:US
Practice Address - Phone:650-692-6648
Practice Address - Fax:650-558-8578
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9283103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1205941994Medicare UPIN