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General NPI Number Information
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NPI Number | 1548430069
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Entity Type | Organization
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Legal Business Name | SAMUEL D LEUNG, S.C.
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Dates
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Enumeration Date | 03/12/2008
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Last Update Date | 04/28/2008
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Provider Practice Location Address
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Address Line | 2142 S ARCHER AVE
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City | CHICAGO
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State | IL
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Zip | 60616-1514
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Country | US
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Telephone | 312-326-1400
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Fax | 312-326-4188
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Provider Business Mailing Address
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Address Line | 3 HILLCREST CT
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City | BURR RIDGE
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State | IL
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Zip | 60527-5757
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Country | US
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Telephone | 630-677-6267
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Fax | 312-326-4188
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | SAMUEL D LEUNG
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Credential | D.O.
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Telephone | 312-326-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 036062409
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License Number State | IL
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