Basic Information
| Provider Information | |||||||||
| NPI: | 1770508558 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHIN | ||||||||
| FirstName: | ELIZA | ||||||||
| MiddleName: | LO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 30TH ST | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946093424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104656700 | ||||||||
| FaxNumber: | 5104657765 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 BAY PLACE | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946108391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108918519 | ||||||||
| FaxNumber: | 5108918518 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 04/15/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | G86509 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | G86509 | 01 | CA | CAL STATE LICENSE | OTHER |