Provider Demographics
NPI:1275348351
Name:KENG, JACQUELINE SHEILA (PA-C)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:SHEILA
Last Name:KENG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14650 AVIATION BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-6670
Mailing Address - Country:US
Mailing Address - Phone:323-306-9632
Mailing Address - Fax:
Practice Address - Street 1:1700 E CESAR E CHAVEZ AVE STE 2500
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2434
Practice Address - Country:US
Practice Address - Phone:323-306-9632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant