Healthcare Provider Details

I. General information

NPI: 1306709522
Provider Name (Legal Business Name): LEANDER KUNG LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8910 N CENTRAL AVE
PHOENIX AZ
85020-2819
US

IV. Provider business mailing address

8910 N CENTRAL AVE
PHOENIX AZ
85020-2819
US

V. Phone/Fax

Practice location:
  • Phone: 269-921-0446
  • Fax:
Mailing address:
  • Phone: 269-921-0446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number30489
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: