Provider Demographics
NPI:1538892617
Name:LEUN, MEGAN KELSEY (DDS)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:KELSEY
Last Name:LEUN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 ROBINSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-7633
Mailing Address - Country:US
Mailing Address - Phone:631-873-7731
Mailing Address - Fax:
Practice Address - Street 1:1807 ROBINSON AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-7633
Practice Address - Country:US
Practice Address - Phone:619-295-1512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1088191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice