Provider Demographics
NPI:1053511519
Name:LEUNG, CHI C (DDS)
Entity type:Individual
Prefix:DR
First Name:CHI
Middle Name:C
Last Name:LEUNG
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 1:411 N CENTRAL AVE STE 360
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2086
Mailing Address - Country:US
Mailing Address - Phone:818-243-3677
Mailing Address - Fax:818-243-6172
Practice Address - Street 1:411 N CENTRAL AVE STE 360
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2086
Practice Address - Country:US
Practice Address - Phone:818-243-3677
Practice Address - Fax:818-243-6172
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43361122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist