Organization
BOSTON FOOD ALLERGY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN LEUNG M.D (OWNER)
(617) 804-6767
Entity
Organization
Contact information
Practice address
88 BELFORT ST, PORTLAND, ME 04103-1258
(207) 807-4308
Mailing address
1 NASSAU STREET UNIT 1906, BOSTON, MA 02111-1587
(178) 046-7676
(877) 726-8492
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
—
—
207RG0100X
Gastroenterology Physician
—
—
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
230907
STATE LICENSE CERTIFICATION
MA
01
—
DI1807
LICENSE
ME
Enumeration date
08/05/2019
Last updated
01/26/2026
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