MEDICARE: JULIA MAI LAN LEONG DDS

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	108854	CA
2	1223P0700X	Prosthodontics	108854	CA

General Provider Information

NPI Number	:	1235810433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA MAI LAN LEONG DDS

Provider Business Mailing Address
First Line	:	20243 ELKWOOD ST
Second Line	:
City	:	WINNETKA
State	:	CA
Zip	:	91306-2313
Country	:	US
Telephone Number	:	818-424-8477
Fax Number	:

Provider Business Practice Location Address
First Line	:	1950 SUNNY CREST DR STE 3000
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92835-3641
Country	:	US
Telephone Number	:	714-455-3823
Fax Number	:

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

Provider Enumeration Date	:	07/31/2023
Last Update Date	:	11/24/2024

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Directions to “ JULIA MAI LAN LEONG DDS” Practice Location

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