Provider Demographics
NPI:1083774996
Name:CHANG, ELI (MD)
Entity Type:Individual
Prefix:
First Name:ELI
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1450 SAN PABLO ST
Mailing Address - Street 2:SUITE 3700
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-4668
Mailing Address - Country:US
Mailing Address - Phone:323-442-7152
Mailing Address - Fax:323-442-7166
Practice Address - Street 1:1450 SAN PABLO ST
Practice Address - Street 2:SUITE 4000
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-4668
Practice Address - Country:US
Practice Address - Phone:323-442-6335
Practice Address - Fax:323-442-7166
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA74459207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA180045317OtherMEDICARE RAILROAD
CA00A744590Medicaid
CA00A744590OtherBLUE SHIELD
CAWA74459AMedicare PIN
CAWA74459BMedicare PIN
CAH14861Medicare UPIN