Provider Demographics
NPI:1427123488
Name:CHANG, ERIC CHENG KUN (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:CHENG KUN
Last Name:CHANG
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 1:600 N GARFIELD AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1169
Mailing Address - Country:US
Mailing Address - Phone:626-571-8080
Mailing Address - Fax:626-571-5520
Practice Address - Street 1:600 N GARFIELD AVE STE 200
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1169
Practice Address - Country:US
Practice Address - Phone:626-571-8080
Practice Address - Fax:626-571-5520
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74401207R00000X, 207RH0000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOG7440100Medicaid
G74401Medicare ID - Type Unspecified
G61086Medicare UPIN