Provider Demographics
NPI:1801784491
Name:LEUNG, NATHAN QUIN (OD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:QUIN
Last Name:LEUNG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 AVONREA RD
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2305
Mailing Address - Country:US
Mailing Address - Phone:562-291-9749
Mailing Address - Fax:
Practice Address - Street 1:520 N LONE HILL AVE
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-1725
Practice Address - Country:US
Practice Address - Phone:909-394-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35958152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist