Individual provider Active NPI

Stacy Leung, PA-C

  • Surgical Physician Assistant
  • Philadelphia, PA
National Provider Identifier
1740795764
Registry record updated Aug 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
MA059527 Issued in PA
Practice address
3400 Spruce St
Philadelphia, PA 19104-4238
Phone
(215) 662-3830
NPI assigned
Dec 13, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X MA059527 PA Primary
Surgical Physician Assistant 363AS0400X 25MP00689300 NJ

Addresses

Primary practice location

3400 Spruce St
Philadelphia, PA 19104-4238

Mailing address

3400 Spruce St
5 Rhoads
Philadelphia, PA 19104-4238
Phone (215) 662-3830

Other practice location 1

1 Brace Rd Ste H
Cherry Hill, NJ 08034-2600
Phone (856) 547-0389

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180109001483 PA Practitioner - Physician Assistant 2365701802 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Penn-Medical GroupGroup PAC ID 6204730955, 3,433 clinicians

Practice addresses (Care Compare)

3400 Spruce St
Philadelphia, PA 19104-4206

3400 Spruce Street 5 White BLDG
Oral and Maxillofacial Surgery Hup
Philadelphia, PA 19104-4206
Phone (215) 829-6079

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
MA059527PAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn-Medical Group CurrentSince Jan 8, 2018 Accepting new patients
University of Penn-Medical Group CurrentSince Jan 8, 2018 Accepting new patients

Locations

3400 Spruce St
Fl 5
Philadelphia, PA 19104
Phone (215) 662-2777

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1513123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785801600000",
    "number": "1740795764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE ST",
            "address_2": "5 RHOADS",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044238",
            "telephone_number": "215-662-3830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044238",
            "telephone_number": "215-662-3830"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Brace Rd Ste H",
            "address_purpose": "LOCATION",
            "city": "Cherry Hill",
            "state": "NJ",
            "postal_code": "080342600",
            "country_code": "US",
            "telephone_number": "856-547-0389",
            "fax_number": "856-325-4293",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEUNG",
        "first_name": "STACY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-13",
        "last_updated": "2026-08-04",
        "certification_date": "2026-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "PA",
            "license": "MA059527",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NJ",
            "license": "25MP00689300",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.