Provider Demographics
NPI:1770508558
Name:CHIN, ELIZA LO (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZA
Middle Name:LO
Last Name:CHIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:350 30TH ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3424
Mailing Address - Country:US
Mailing Address - Phone:510-465-6700
Mailing Address - Fax:510-465-7765
Practice Address - Street 1:100 BAY PLACE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-8391
Practice Address - Country:US
Practice Address - Phone:510-891-8519
Practice Address - Fax:510-891-8518
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG86509207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG86509OtherCAL STATE LICENSE
G20882Medicare UPIN
CA00G865090Medicare ID - Type Unspecified