Provider Demographics
NPI:1255478178
Name:LO, HENRY HUNG CHEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:HUNG CHEE
Last Name:LO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:310 GLENULLEN DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2100
Mailing Address - Country:US
Mailing Address - Phone:323-255-3039
Mailing Address - Fax:323-255-3039
Practice Address - Street 1:6360 WILSHIRE BLVD
Practice Address - Street 2:STE. 403
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5603
Practice Address - Country:US
Practice Address - Phone:323-653-9440
Practice Address - Fax:323-653-3586
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA354221223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA35422Medicaid