Provider Demographics
NPI:1679559579
Name:HO, LARRY C (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:C
Last Name:HO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15701 ROCKFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2801
Mailing Address - Country:US
Mailing Address - Phone:949-457-9900
Mailing Address - Fax:949-457-9922
Practice Address - Street 1:15701 ROCKFIELD BLVD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2801
Practice Address - Country:US
Practice Address - Phone:949-457-9900
Practice Address - Fax:949-457-9922
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45709174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE17550Medicare UPIN
CAWA45709DMedicare ID - Type Unspecified