Provider Demographics
NPI:1326266537
Name:CHRISTIAN, EUGENE (EUGENE CHRISTIAN)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:
Last Name:CHRISTIAN
Suffix:
Gender:M
Credentials:EUGENE CHRISTIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 431687
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-9687
Mailing Address - Country:US
Mailing Address - Phone:310-671-3328
Mailing Address - Fax:
Practice Address - Street 1:101 N LA BREA AVE
Practice Address - Street 2:306
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1769
Practice Address - Country:US
Practice Address - Phone:310-671-3328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44734207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G447340Medicaid
G44734Medicare ID - Type Unspecified