Provider Demographics
NPI:1407868680
Name:LOO, LORREN L (MD)
Entity Type:Individual
Prefix:
First Name:LORREN
Middle Name:L
Last Name:LOO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 SOUTH BERETANIA STREET #201 #202
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1149
Mailing Address - Country:US
Mailing Address - Phone:808-946-1712
Mailing Address - Fax:808-946-1728
Practice Address - Street 1:1575 SOUTH BERETANIA STREET #201 #202
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1149
Practice Address - Country:US
Practice Address - Phone:808-946-1712
Practice Address - Fax:808-946-1728
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI12869207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI55435401Medicaid
HI0000248450OtherHMSA
HI0000248450OtherHMSA
HI55435401Medicaid