Provider Demographics
NPI:1558387340
Name:BRIAN B. LO, MD INC.
Entity Type:Organization
Organization Name:BRIAN B. LO, MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-503-5112
Mailing Address - Street 1:7545 IRVINE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2933
Mailing Address - Country:US
Mailing Address - Phone:949-503-5112
Mailing Address - Fax:949-503-5113
Practice Address - Street 1:7545 IRVINE CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2933
Practice Address - Country:US
Practice Address - Phone:949-503-5112
Practice Address - Fax:949-503-5113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68666207R00000X
207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19768Medicare PIN