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General NPI Number Information
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NPI Number | 1679219257
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Entity Type | Individual
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Provider Name | KIM LEONG PH.D.
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Gender | Female
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Dates
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Enumeration Date | 05/07/2022
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Last Update Date | 10/28/2022
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Provider Practice Location Address
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Address Line | TRUMAN GROUP, LLC; 241 CLEVELAND AVE. S.
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City | ST. PAUL
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State | MN
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Zip | 55105
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Country | US
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Telephone | 651-371-5559
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Fax |
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Provider Business Mailing Address
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Address Line | UNIT 6350 BOX 5025
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City | DPO
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State | AE
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Zip | 09847-5025
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Country | US
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Telephone | 360-670-4349
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY12676
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License Number State | CA
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