Healthcare Provider Details

I. General information

NPI: 1750847372
Provider Name (Legal Business Name): SAMANTHA KELLY LEUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6842 VAN NUYS BLVD FL 2
VAN NUYS CA
91405-4650
US

IV. Provider business mailing address

1946 S BEDFORD ST APT 2
LOS ANGELES CA
90034-1331
US

V. Phone/Fax

Practice location:
  • Phone: 818-994-7614
  • Fax:
Mailing address:
  • Phone: 562-552-5272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: