Provider Demographics
NPI:1043878895
Name:HENG, EILEEN
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:HENG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7392 BRADLEY DR
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-1401
Mailing Address - Country:US
Mailing Address - Phone:562-688-2641
Mailing Address - Fax:
Practice Address - Street 1:1110 W LA PALMA AVE STE 1
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2822
Practice Address - Country:US
Practice Address - Phone:714-991-3180
Practice Address - Fax:714-742-7729
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008714208000000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics