Provider Demographics
NPI:1104580893
Name:LEUNG, ALAN CHICHUEN
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:CHICHUEN
Last Name:LEUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21407 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3326
Mailing Address - Country:US
Mailing Address - Phone:347-981-9759
Mailing Address - Fax:
Practice Address - Street 1:8277 BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-3352
Practice Address - Country:US
Practice Address - Phone:718-672-7781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068558183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist