Provider Demographics
NPI:1417226952
Name:LO, ANDREA YAN-SIN
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:YAN-SIN
Last Name:LO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5839 S MARYLAND AVE
Mailing Address - Street 2:WP C-411 / MC 4062
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1463
Mailing Address - Country:US
Mailing Address - Phone:773-702-6175
Mailing Address - Fax:773-702-1192
Practice Address - Street 1:5839 S MARYLAND AVE
Practice Address - Street 2:WP C-411 / MC 4062
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1463
Practice Address - Country:US
Practice Address - Phone:773-702-6175
Practice Address - Fax:773-702-1192
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1289242086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery