Provider Demographics
NPI:1659609345
Name:LLOYD K ITO,M.D,APC
Entity Type:Organization
Organization Name:LLOYD K ITO,M.D,APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,CEO
Authorized Official - Prefix:
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:K
Authorized Official - Last Name:ITO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-366-0565
Mailing Address - Street 1:10515 BALBOA BLVD STE 325
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6364
Mailing Address - Country:US
Mailing Address - Phone:818-366-0565
Mailing Address - Fax:818-366-6383
Practice Address - Street 1:10515 BALBOA BLVD STE 325
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6364
Practice Address - Country:US
Practice Address - Phone:818-366-0565
Practice Address - Fax:818-366-6383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51268207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA51952Medicare UPIN