1295711810 NPI number — CHRISTINE LOO MD

Table of content: CHRISTINE LOO MD (NPI 1295711810)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295711810 NPI number — CHRISTINE LOO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOO
Provider First Name:
CHRISTINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295711810
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 660599
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75266-0599
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3310 LIVE OAK ST
Provider Second Line Business Practice Location Address:
COPC ADMINISTRATION
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75204-6153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-266-1247
Provider Business Practice Location Address Fax Number:
214-266-1246
Provider Enumeration Date:
12/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  L4539 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 155632614 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 155632622 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 155632621 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 155632605 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 155632607 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 155632615 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 155632624 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 155632602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 155632610 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 155632616 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 155632625 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 155632609 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 155632619 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 155632604 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 155632620 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 155632606 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 155632608 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 155632612 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 155632617 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 155632623 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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