Healthcare Provider Details

I. General information

NPI: 1164545869
Provider Name (Legal Business Name): EDWIN MAN KIN LEUNG DDS, M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E MEDICAL CENTER DR
ANN ARBOR MI
48109-0999
US

IV. Provider business mailing address

300 SE 120TH AVE STE 800
VANCOUVER WA
98683-4094
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-5732
  • Fax:
Mailing address:
  • Phone: 360-260-3290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2901018359
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301087381
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDE60019072
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: