Healthcare Provider Details

I. General information

NPI: 1528983004
Provider Name (Legal Business Name): LEONG DENTAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 PENINSULA AVE
SAN MATEO CA
94401-1653
US

IV. Provider business mailing address

420 PENINSULA AVE
SAN MATEO CA
94401-1653
US

V. Phone/Fax

Practice location:
  • Phone: 650-342-3597
  • Fax:
Mailing address:
  • Phone: 650-342-3597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. WAYMOND K LEONG
Title or Position: CO-OWNER
Credential: DDS
Phone: 650-342-3597