Provider Demographics
NPI:1225283195
Name:LOR, PAO CHOUA
Entity Type:Individual
Prefix:
First Name:PAO
Middle Name:CHOUA
Last Name:LOR
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 1:4552 MEADOW WAY
Mailing Address - Street 2:
Mailing Address - City:OLIVEHURST
Mailing Address - State:CA
Mailing Address - Zip Code:95961-4527
Mailing Address - Country:US
Mailing Address - Phone:530-455-5440
Mailing Address - Fax:
Practice Address - Street 1:4552 MEADOW WY
Practice Address - Street 2:
Practice Address - City:OLIVEHURST
Practice Address - State:CA
Practice Address - Zip Code:95961
Practice Address - Country:US
Practice Address - Phone:530-923-2136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver