Healthcare Provider Details

I. General information

NPI: 1568552636
Provider Name (Legal Business Name): LENG CHUNG HAONG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 SHAW AVE SUITE B
CLOVIS CA
93612-3950
US

IV. Provider business mailing address

251 W SERENA AVE
CLOVIS CA
93619-3794
US

V. Phone/Fax

Practice location:
  • Phone: 559-323-1776
  • Fax:
Mailing address:
  • Phone: 559-305-2219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number50265
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: