Healthcare Provider Details

I. General information

NPI: 1215282355
Provider Name (Legal Business Name): ANDREA KAREN LEUNG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2012
Last Update Date: 07/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-3017
  • Fax: 202-476-6520
Mailing address:
  • Phone: 202-476-3017
  • Fax: 202-476-6520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD040624
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0116024308
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: