Provider Demographics
NPI:1053987701
Name:MENON, LEENA UNNIKRISHNAN
Entity type:Individual
Prefix:DR
First Name:LEENA
Middle Name:UNNIKRISHNAN
Last Name:MENON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11312 124TH AVE NE UNIT 202
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-4646
Mailing Address - Country:US
Mailing Address - Phone:425-362-2418
Mailing Address - Fax:
Practice Address - Street 1:PUGET SOUND PEDIATRIC DENTISTRY
Practice Address - Street 2:919 STATE AVE #104
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270
Practice Address - Country:US
Practice Address - Phone:360-659-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61533511223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry