Provider Demographics
NPI:1265459747
Name:RAJU, CECILIA CHANG (OD)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:CHANG
Last Name:RAJU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CECILIA
Other - Middle Name:HUI-HSIN
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2218 MARSHALLFIELD LN UNIT A
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-5016
Mailing Address - Country:US
Mailing Address - Phone:626-665-6344
Mailing Address - Fax:
Practice Address - Street 1:15446 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-4319
Practice Address - Country:US
Practice Address - Phone:310-217-5370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12279T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist