Healthcare Provider Details

I. General information

NPI: 1134297088
Provider Name (Legal Business Name): JOHN WILLIAM LEYMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 POMONA AVE
LONG BEACH CA
90803-3401
US

IV. Provider business mailing address

191 POMONA AVE
LONG BEACH CA
90803-3401
US

V. Phone/Fax

Practice location:
  • Phone: 562-682-2726
  • Fax: 714-333-4966
Mailing address:
  • Phone: 562-682-2726
  • Fax: 714-333-4966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number27643
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: