Healthcare Provider Details

I. General information

NPI: 1093055410
Provider Name (Legal Business Name): HEEYEON INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2013
Last Update Date: 02/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S BROOKHURST RD SUITE 101
FULLERTON CA
92833-3700
US

IV. Provider business mailing address

1001 S BROOKHURST RD SUITE 101
FULLERTON CA
92833-3700
US

V. Phone/Fax

Practice location:
  • Phone: 714-879-9988
  • Fax: 714-879-1885
Mailing address:
  • Phone: 714-879-9988
  • Fax: 714-879-1885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: HEEYEON KIM
Title or Position: PRESIDENT
Credential: OTR
Phone: 714-393-2990