Active NPI
Jessica Lim Leong, DDS
- General Practice Dentistry
- City of Industry, CA
National Provider Identifier
1336592906
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DDS100389
- Practice address
- 21750 Valley Blvd Ste C
City of Industry, CA 91789-0939 - Phone
- (626) 592-2556
- NPI assigned
- Jul 19, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DDS100389 | CA | Primary |
Addresses
Primary practice location
21750 Valley Blvd Ste C
City of Industry, CA 91789-0939
Mailing address
1220 S Raymond Ave
Alhambra, CA 91803-2337
Phone (626) 592-2556
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170622000788 | CA | Order and Referring Only - Dentist | 4789952300 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DDS100389 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468886400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472515200000",
"number": "1336592906",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1220 S RAYMOND AVE",
"city": "ALHAMBRA",
"state": "CA",
"postal_code": "918032337",
"telephone_number": "626-592-2556"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21750 VALLEY BLVD STE C",
"city": "CITY OF INDUSTRY",
"state": "CA",
"postal_code": "917890939",
"telephone_number": "626-592-2556"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEONG",
"first_name": "JESSICA",
"middle_name": "LIM",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-07-19",
"last_updated": "2016-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "DDS100389",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in City of Industry, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2016; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.