Provider Demographics
NPI:1649423161
Name:LO, JOHN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:LO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:JEN-HUNG
Other - Middle Name:
Other - Last Name:LO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:3244 SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-2719
Mailing Address - Country:US
Mailing Address - Phone:310-320-5661
Mailing Address - Fax:
Practice Address - Street 1:3708 MAIN ST STE 4F
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-6509
Practice Address - Country:US
Practice Address - Phone:718-886-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054062122300000X
CA602631223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist