Healthcare Provider Details

I. General information

NPI: 1508868902
Provider Name (Legal Business Name): CHRISTINA YEE YEN LEUNG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2716 TIBBETS DR
BEDFORD TX
76022-6915
US

IV. Provider business mailing address

PO BOX 733784
DALLAS TX
75373-3784
US

V. Phone/Fax

Practice location:
  • Phone: 817-571-6644
  • Fax: 817-685-7951
Mailing address:
  • Phone: 682-885-1855
  • Fax: 682-885-1396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK3920
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: