Basic Information
| Provider Information | |||||||||
| NPI: | 1083774996 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHANG | ||||||||
| FirstName: | ELI | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1450 SAN PABLO ST | ||||||||
| Address2: | SUITE 3700 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900334668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234427152 | ||||||||
| FaxNumber: | 3234427166 | ||||||||
| Practice Location | |||||||||
| Address1: | 1450 SAN PABLO ST | ||||||||
| Address2: | SUITE 4000 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900334668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234426335 | ||||||||
| FaxNumber: | 3234427166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 12/07/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | A74459 | CA | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 180045317 | 01 | CA | MEDICARE RAILROAD | OTHER | 00A744590 | 05 | CA | MEDICAID | 00A744590 | 01 | CA | BLUE SHIELD | OTHER |