Provider Demographics
NPI:1043276140
Name:LO, GARLAN G (MD)
Entity Type:Individual
Prefix:
First Name:GARLAN
Middle Name:G
Last Name:LO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1850 S AZUSA AVE
Mailing Address - Street 2:STE 107
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-6813
Mailing Address - Country:US
Mailing Address - Phone:626-912-6888
Mailing Address - Fax:626-913-9281
Practice Address - Street 1:1850 S AZUSA AVE
Practice Address - Street 2:STE 107
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-6813
Practice Address - Country:US
Practice Address - Phone:626-912-6888
Practice Address - Fax:626-913-9281
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2008-01-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG57913207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G579130Medicaid
CAE02822Medicare UPIN
CA0754240001Medicare NSC
CAG57913Medicare PIN