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General NPI Number Information
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NPI Number | 1083799068
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Entity Type | Organization
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Legal Business Name | A STREET DENTAL CLINIC
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 902 A ST SE SUITE A
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City | AUBURN
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State | WA
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Zip | 98002-6056
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Country | US
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Telephone | 253-288-9608
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Fax | 253-288-9631
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Provider Business Mailing Address
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Address Line | 702 SW 294TH ST
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City | FEDERAL WAY
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State | WA
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Zip | 98023-3542
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Country | US
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Telephone | 253-288-9608
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Fax | 253-288-9631
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Authorized Official
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Title or Position | PRACTICE OWNER/DENTIST
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Name | KEVIN C LEUNG
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Credential | D.D.S.
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Telephone | 253-288-9608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9810
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License Number State | WA
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