Provider Demographics
NPI:1912507708
Name:HSIUNG, EILEEN (RDN)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:HSIUNG
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 POLARIS DR
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-1720
Mailing Address - Country:US
Mailing Address - Phone:949-870-7506
Mailing Address - Fax:
Practice Address - Street 1:830 POLARIS DR
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-1720
Practice Address - Country:US
Practice Address - Phone:949-870-7506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA893347133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered