Provider Demographics
NPI:1164453015
Name:LO, HERBERT K (DPM)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:K
Last Name:LO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 S UNION AVE
Mailing Address - Street 2:B 4001
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1804
Mailing Address - Country:US
Mailing Address - Phone:253-572-4848
Mailing Address - Fax:253-572-1803
Practice Address - Street 1:1901 S UNION AVE
Practice Address - Street 2:B 4001
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1804
Practice Address - Country:US
Practice Address - Phone:253-572-4848
Practice Address - Fax:253-572-1803
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000196213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14782OtherL & I
WA1509900Medicaid
480026084OtherRAILROAD MEDICARE
L00183OtherREGENCE
T01697Medicare UPIN
14782OtherL & I
WA1509900Medicaid