Healthcare Provider Details

I. General information

NPI: 1679621981
Provider Name (Legal Business Name): MICHELLE M. HENG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15809 BEAR CREEK PKWY STE 100
REDMOND WA
98052-1542
US

IV. Provider business mailing address

15809 BEAR CREEK PKWY STE 100
REDMOND WA
98052-1542
US

V. Phone/Fax

Practice location:
  • Phone: 425-882-6100
  • Fax:
Mailing address:
  • Phone: 425-882-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00036155
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: