Provider Demographics
NPI:1619972700
Name:LOO, JOHN-CHARLES AIONA
Entity Type:Individual
Prefix:
First Name:JOHN-CHARLES
Middle Name:AIONA
Last Name:LOO
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 1:3080 BRISTOL ST
Mailing Address - Street 2:STE 600
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3093
Mailing Address - Country:US
Mailing Address - Phone:714-445-0220
Mailing Address - Fax:714-445-0245
Practice Address - Street 1:2801 ATLANTIC AVE
Practice Address - Street 2:3RD FLOOR PEDIATRICS
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1701
Practice Address - Country:US
Practice Address - Phone:562-933-3350
Practice Address - Fax:562-933-3359
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA672002080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology