Provider Demographics
NPI:1174133102
Name:HENG, ANNIE (RN, BSN)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:HENG
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13080 PACIFIC PROMENADE APT 108
Mailing Address - Street 2:
Mailing Address - City:PLAYA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:90094-2112
Mailing Address - Country:US
Mailing Address - Phone:310-351-7824
Mailing Address - Fax:
Practice Address - Street 1:13080 PACIFIC PROMENADE APT 108
Practice Address - Street 2:
Practice Address - City:PLAYA VISTA
Practice Address - State:CA
Practice Address - Zip Code:90094-2112
Practice Address - Country:US
Practice Address - Phone:310-351-7824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA540112163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse