MEDICARE: SUSAN LEUNG DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	25783	CA

General Provider Information

NPI Number	:	1023454626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN LEUNG DDS INC

Provider Business Mailing Address
First Line	:	1506 HUNTINGTON DR
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-4520
Country	:	US
Telephone Number	:	626-799-2888
Fax Number	:

Provider Business Practice Location Address
First Line	:	1506 HUNTINGTON DR
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-4520
Country	:	US
Telephone Number	:	626-799-2888
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. SUSAN LEUNG
Credential	:	DDS
Telephone Number	:	626-799-2888

Provider Enumeration Date	:	05/22/2013
Last Update Date	:	05/22/2013

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