MEDICARE: WAI TAK LEUNG DDS

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	122300000X	Dentist	63374	NY

General Provider Information

NPI Number	:	1255073631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAI TAK LEUNG DDS

Provider Business Mailing Address
First Line	:	714 58TH ST STE 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-5176
Country	:	US
Telephone Number	:	718-310-9812
Fax Number	:

Provider Business Practice Location Address
First Line	:	714 58TH ST STE 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-5176
Country	:	US
Telephone Number	:	718-688-1100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2022
Last Update Date	:	06/29/2026

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