Provider Demographics
NPI:1104066620
Name:LEUNG, JOHNNY W (LAC)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:W
Last Name:LEUNG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 90339
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-0339
Mailing Address - Country:US
Mailing Address - Phone:917-861-3699
Mailing Address - Fax:917-861-3699
Practice Address - Street 1:18 E. 41ST STREET #1407
Practice Address - Street 2:C/O LINA
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-2065
Practice Address - Country:US
Practice Address - Phone:917-861-3699
Practice Address - Fax:866-200-0396
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004018171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist