Provider Demographics
NPI:1780332379
Name:HENG, JONATHAN DARA (OTD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DARA
Last Name:HENG
Suffix:
Gender:M
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23180 HEMLOCK AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-8001
Mailing Address - Country:US
Mailing Address - Phone:951-266-9880
Mailing Address - Fax:951-289-7964
Practice Address - Street 1:23180 HEMLOCK AVE STE 100
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-8001
Practice Address - Country:US
Practice Address - Phone:951-266-9880
Practice Address - Fax:951-289-7964
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21332225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist