Healthcare Provider Details

I. General information

NPI: 1447328711
Provider Name (Legal Business Name): JOHN LEUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2006
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 HARRISON AVE STE 201
BOSTON MA
02111-1924
US

IV. Provider business mailing address

1 NASSAU ST UNIT 1906
BOSTON MA
02111-1587
US

V. Phone/Fax

Practice location:
  • Phone: 617-804-6767
  • Fax: 877-726-8492
Mailing address:
  • Phone: 617-804-6767
  • Fax: 877-726-8492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License Number230907
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number230907
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number230907
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number230907
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: