MEDICARE: DR. GAYLA A LEUNG D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2251	HI

General Provider Information

NPI Number	:	1003902891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAYLA A LEUNG D.D.S.

Provider Business Mailing Address
First Line	:	615 PIIKOI ST STE 1806
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96814-3142
Country	:	US
Telephone Number	:	808-593-7555
Fax Number	:	808-597-1619

Provider Business Practice Location Address
First Line	:	615 PIIKOI ST STE 1806
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96814-3142
Country	:	US
Telephone Number	:	808-593-7555
Fax Number	:	808-597-1619

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	07/08/2007

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