Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DDS100461 | CA |
NPI | 1013329770 |
---|---|
Provider Name | Dr. Kelly Kimiko Leong |
First Address | San Francisco, CA 94118-3316 |
Second Address | San Francisco, CA 94118-3316 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2014 |
Last Update Date | 29/11/2018 |