Provider Demographics
NPI:1033313937
Name:LO, LOON-TZIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LOON-TZIAN
Middle Name:
Last Name:LO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6113 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63133-2616
Mailing Address - Country:US
Mailing Address - Phone:314-925-7525
Mailing Address - Fax:314-658-9374
Practice Address - Street 1:6113 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63133-2616
Practice Address - Country:US
Practice Address - Phone:314-925-7525
Practice Address - Fax:314-658-9374
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO19991378802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1033313937Medicaid
MOH32032Medicare UPIN
MO1033313937Medicaid