Healthcare Provider Details

I. General information

NPI: 1689432320
Provider Name (Legal Business Name): HENA THOPPIL LONAPPAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4199 CAMPUS DR STE 550
IRVINE CA
92612-4694
US

IV. Provider business mailing address

19200 VON KARMAN AVE STE 350
IRVINE CA
92612-8509
US

V. Phone/Fax

Practice location:
  • Phone: 949-202-7566
  • Fax: 949-437-3428
Mailing address:
  • Phone: 949-202-7566
  • Fax: 949-437-3428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA64077
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: