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General NPI Number Information
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NPI Number | 1265786842
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Entity Type | Organization
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Legal Business Name | DR. KALLI LEUNG, O.D., PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 11/02/2012
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Last Update Date | 03/14/2014
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Provider Practice Location Address
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Address Line | 1371 E 14TH ST STE A
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City | SAN LEANDRO
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State | CA
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Zip | 94577-4728
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Country | US
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Telephone | 510-895-2020
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Fax | 510-895-2393
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Provider Business Mailing Address
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Address Line | 1371 E 14TH ST STE A
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City | SAN LEANDRO
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State | CA
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Zip | 94577-4728
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Country | US
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Telephone | 510-895-2020
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Fax | 510-895-2393
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KALLI K LEUNG
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Credential | O.D.
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Telephone | 510-895-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 13609TLG
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License Number State | CA
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