Provider Demographics
NPI:1104151653
Name:LEUNG, WILSON KENNETH (DMD)
Entity type:Individual
Prefix:
First Name:WILSON
Middle Name:KENNETH
Last Name:LEUNG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 SOUTH ATLANTIC AVENUE
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:CA
Mailing Address - Zip Code:90201
Mailing Address - Country:US
Mailing Address - Phone:323-562-9222
Mailing Address - Fax:323-562-9209
Practice Address - Street 1:6901 SOUTH ATLANTIC AVENUE
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201
Practice Address - Country:US
Practice Address - Phone:323-562-9222
Practice Address - Fax:323-562-9209
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58224122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist