Provider Demographics
NPI:1336592906
Name:LEONG, JESSICA LIM (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LIM
Last Name:LEONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 S RAYMOND AVE
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-2337
Mailing Address - Country:US
Mailing Address - Phone:626-592-2556
Mailing Address - Fax:
Practice Address - Street 1:21750 VALLEY BLVD STE C
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91789-0939
Practice Address - Country:US
Practice Address - Phone:626-592-2556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1003891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice