Healthcare Provider Details

I. General information

NPI: 1255073631
Provider Name (Legal Business Name): WAI TAK LEUNG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 58TH ST STE 1
BROOKLYN NY
11220-5176
US

IV. Provider business mailing address

714 58TH ST STE 1
BROOKLYN NY
11220-5176
US

V. Phone/Fax

Practice location:
  • Phone: 718-688-1100
  • Fax:
Mailing address:
  • Phone: 718-688-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number63374
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: