Healthcare Provider Details

I. General information

NPI: 1912507708
Provider Name (Legal Business Name): EILEEN HSIUNG RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2020
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 POLARIS DR
TUSTIN CA
92782-1720
US

IV. Provider business mailing address

830 POLARIS DR
TUSTIN CA
92782-1720
US

V. Phone/Fax

Practice location:
  • Phone: 949-870-7506
  • Fax:
Mailing address:
  • Phone: 949-870-7506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number893347
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: