Individual
DR. DANIEL KRUK-LEAHY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
1401 AVOCADO AVE STE 404, NEWPORT BEACH, CA 92660-7783
(213) 364-9120
Mailing address
8809 WASHINGTON BLVD APT 410, CULVER CITY, CA 90232-4211
(213) 364-9120
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
106402
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
97706578F90105
—
CA
Enumeration date
05/29/2020
Last updated
05/30/2024
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