=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851623201
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TINGHIM LEUNG D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2010
-----------------------------------------------------
Last Update Date | 02/01/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4161 KISSENA BLVD SUITE 22
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11355-3181
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-244-8415
-----------------------------------------------------
Fax | 516-593-2757
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 106 KENT RD
-----------------------------------------------------
City | VALLEY STREAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11580-3316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-244-8415
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | X012023-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------