Healthcare Provider Details

I. General information

NPI: 1477607497
Provider Name (Legal Business Name): SHANNON CHANG EATON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99128 AIEA HGTS DR #304
AIEA HI
96701
US

IV. Provider business mailing address

99128 AIEA HGTS DR #304
AIEA HI
96701
US

V. Phone/Fax

Practice location:
  • Phone: 808-487-0086
  • Fax: 808-486-6894
Mailing address:
  • Phone: 808-487-0086
  • Fax: 808-486-6894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number3428
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: