Healthcare Provider Details

I. General information

NPI: 1184053480
Provider Name (Legal Business Name): CONNIE CHEN LEUNG PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9094 E MINERAL AVE SUITE 100
CENTENNIAL CO
80112-7201
US

IV. Provider business mailing address

9094 E MINERAL AVE SUITE 100
CENTENNIAL CO
80112-7201
US

V. Phone/Fax

Practice location:
  • Phone: 303-694-3200
  • Fax: 303-694-2680
Mailing address:
  • Phone: 303-694-3200
  • Fax: 303-694-2680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.0003790
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0003790
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: