Derek Leung, D.M.D

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN1856929 Issued in MA

Practice address

1 Kneeland St
Boston, MA 02111-1527

Phone

(307) 363-1515

NPI assigned

Jun 29, 2015

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Nov 27, 2018 through Nov 27, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• San Marcos Pediatric Dentistry and Orthodontics

  • Pediatric Dentistry
  • San Marcos, TX
  • NPI 1750032504
  NPD Authorized official
• Town Center Orthodontics LLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Wayland, MA
  • NPI 1538503099
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1435536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577059200000",
    "number": "1306228168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 ADAMARY PL",
            "city": "PINE BROOK",
            "state": "NJ",
            "postal_code": "070589702",
            "telephone_number": "307-363-1515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 KNEELAND ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021111527",
            "telephone_number": "307-363-1515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEUNG",
        "first_name": "DEREK",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-29",
        "last_updated": "2019-12-23",
        "certification_date": "2019-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN1856929",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MA",
            "license": "DN1856929",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Monmaney Letourneau, RN-C, ANP-BC
• Janelle Letts
• Michael Joseph Leukam, M.D.
• Angela Qiuqi Leung, MD
• Chiu Shan Leung, R.N.,C.N.M.
• Doug Leung, DMD
• Gerry Leung
• Jessica Ho-Shan Leung, PHARMD
• John Leung, M.D.
• Lester Yuqun Leung, M.D.

• Pediatric Dentistry in Boston, MA
• Providers in Boston, MA by specialty
• Pediatric Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.