Provider Demographics
NPI:1730335472
Name:LEUNG, KALLI K (OD)
Entity type:Individual
Prefix:
First Name:KALLI
Middle Name:K
Last Name:LEUNG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1371 E 14TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4728
Mailing Address - Country:US
Mailing Address - Phone:510-895-2020
Mailing Address - Fax:
Practice Address - Street 1:1371 E 14TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4728
Practice Address - Country:US
Practice Address - Phone:510-895-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13609152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACN947Medicare PIN