Provider Demographics
NPI:1164404935
Name:HENG, MADALENE C (MD)
Entity Type:Individual
Prefix:DR
First Name:MADALENE
Middle Name:C
Last Name:HENG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 FLOWER ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-3015
Mailing Address - Country:US
Mailing Address - Phone:818-637-2000
Mailing Address - Fax:818-242-8761
Practice Address - Street 1:14901 RINALDI ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1204
Practice Address - Country:US
Practice Address - Phone:818-838-6716
Practice Address - Fax:818-838-9279
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA31967207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A319670Medicaid
CA050394OtherBLUE CROSS
CARHM18553HMedicaid
CARHM08608FMedicaid
CAZZT40394FMedicaid
CARHM08609FMedicaid
CAWA31967DMedicare ID - Type UnspecifiedPPIN
CA058608Medicare ID - Type UnspecifiedRH MEDICARE
CA058553Medicare ID - Type UnspecifiedRH MEDICARE
CAWA31967GMedicare ID - Type UnspecifiedPPIN
CA050394Medicare ID - Type UnspecifiedMEDICARE
CAZZT40394FMedicaid
CARHM08608FMedicaid
CA050394OtherBLUE CROSS
CAWA31967BMedicare ID - Type Unspecified
CA00A319670Medicaid
CAWA31967HMedicare ID - Type UnspecifiedPPIN
CARHM18553HMedicaid
CARHM08609FMedicaid