Provider Demographics
NPI:1477607497
Name:EATON, SHANNON CHANG (MD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:CHANG
Last Name:EATON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99128 AIEA HGTS DR
Mailing Address - Street 2:#304
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701
Mailing Address - Country:US
Mailing Address - Phone:808-487-0086
Mailing Address - Fax:808-486-6894
Practice Address - Street 1:99128 AIEA HGTS DR
Practice Address - Street 2:#304
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701
Practice Address - Country:US
Practice Address - Phone:808-487-0086
Practice Address - Fax:808-486-6894
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3428207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000BDGSVMedicare ID - Type Unspecified
E77111Medicare UPIN