Provider Demographics
NPI:1265432991
Name:CHANG, EUGENE Y (MD)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:Y
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14726 RAMONA AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5730
Mailing Address - Country:US
Mailing Address - Phone:626-305-9100
Mailing Address - Fax:626-305-0152
Practice Address - Street 1:2619 E COLORADO BLVD STE 150
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3747
Practice Address - Country:US
Practice Address - Phone:626-793-4168
Practice Address - Fax:626-793-6256
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036111048207W00000X
ORMD183525207W00000X, 207WX0107X
CAA77825207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036111048Medicaid
CA1265432991Medicaid