Healthcare Provider Details

I. General information

NPI: 1578811881
Provider Name (Legal Business Name): TIMOTHY ENG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 09/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 E 1ST ST STE 100
SANTA ANA CA
92701-6341
US

IV. Provider business mailing address

1540 E 1ST ST STE 100
SANTA ANA CA
92701-6341
US

V. Phone/Fax

Practice location:
  • Phone: 714-972-3700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: