1689617904 NPI number — KUANG-CHIH LO D.O.

Table of content: KUANG-CHIH LO D.O. (NPI 1689617904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689617904 NPI number — KUANG-CHIH LO D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LO
Provider First Name:
KUANG-CHIH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LO
Provider Other First Name:
KC
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1689617904
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 OCEANGATE
Provider Second Line Business Mailing Address:
#100
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90802-4317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-499-6191
Provider Business Mailing Address Fax Number:
562-499-6171

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 E COOLEY DR
Provider Second Line Business Practice Location Address:
#106
Provider Business Practice Location Address City Name:
COLTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92324-3941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-825-8375
Provider Business Practice Location Address Fax Number:
909-825-3276
Provider Enumeration Date:
06/14/2006

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: 207Q00000X , with the licence number:  20A6260 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00AX62600 . This is a "MEDI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00AX62600 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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