Provider Demographics
NPI:1164844965
Name:LO, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2282 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-1703
Mailing Address - Country:US
Mailing Address - Phone:415-665-9472
Mailing Address - Fax:415-252-3889
Practice Address - Street 1:2282 21ST AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-1703
Practice Address - Country:US
Practice Address - Phone:415-665-9472
Practice Address - Fax:415-252-3889
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-13
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist