Provider Demographics
NPI:1689617904
Name:LO, KUANG-CHIH (DO)
Entity Type:Individual
Prefix:
First Name:KUANG-CHIH
Middle Name:
Last Name:LO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:KC
Other - Middle Name:
Other - Last Name:LO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:200 OCEANGATE
Mailing Address - Street 2:#100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4317
Mailing Address - Country:US
Mailing Address - Phone:562-499-6191
Mailing Address - Fax:562-499-6171
Practice Address - Street 1:1001 E COOLEY DR
Practice Address - Street 2:#106
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3941
Practice Address - Country:US
Practice Address - Phone:909-825-8375
Practice Address - Fax:909-825-3276
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6260207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX62600OtherMEDI-CAL
CA00AX62600Medicaid
CA00AX62600OtherMEDI-CAL
CA00AX62600Medicaid