Provider Demographics
NPI:1568794824
Name:EAPEN, BLESSEN CHACKO (MD)
Entity Type:Individual
Prefix:DR
First Name:BLESSEN
Middle Name:CHACKO
Last Name:EAPEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:310-301-5200
Mailing Address - Fax:
Practice Address - Street 1:200 UCLA MEDICAL PLZ STE 420
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1339
Practice Address - Country:US
Practice Address - Phone:310-206-6232
Practice Address - Fax:917-660-7942
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101246756208100000X, 390200000X
CAC153716208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program