Healthcare Provider Details

I. General information

NPI: 1043878895
Provider Name (Legal Business Name): EILEEN HENG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 W LA PALMA AVE STE 1
ANAHEIM CA
92801-2822
US

IV. Provider business mailing address

7392 BRADLEY DR
BUENA PARK CA
90620-1401
US

V. Phone/Fax

Practice location:
  • Phone: 714-991-3180
  • Fax: 714-742-7729
Mailing address:
  • Phone: 562-688-2641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95008714
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number95008714
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: