Provider Demographics
NPI:1235810433
Name:LEONG, JULIA MAI LAN (DDS)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:MAI LAN
Last Name:LEONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:MAI LAN
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:20243 ELKWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-2313
Mailing Address - Country:US
Mailing Address - Phone:818-424-8477
Mailing Address - Fax:
Practice Address - Street 1:1950 SUNNY CREST DR STE 3000
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3641
Practice Address - Country:US
Practice Address - Phone:714-455-3823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2024-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108854122300000X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist