Healthcare Provider Details

I. General information

NPI: 1184672917
Provider Name (Legal Business Name): KHYE SHENG ANDREI LEONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 MEMORIAL CT
JACKSONVILLE NC
28546-6322
US

IV. Provider business mailing address

PO BOX 986513 DEPARTMENT 100
BOSTON MA
02298-6513
US

V. Phone/Fax

Practice location:
  • Phone: 910-353-3200
  • Fax: 910-353-0600
Mailing address:
  • Phone: 910-219-8326
  • Fax: 910-939-4269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number9800311
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: