Provider Demographics
NPI:1730470121
Name:LO, DAPHNE TAK WAI (MD)
Entity Type:Individual
Prefix:
First Name:DAPHNE
Middle Name:TAK WAI
Last Name:LO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 N SAN MATEO DR STE 1
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2794
Mailing Address - Country:US
Mailing Address - Phone:650-425-9408
Mailing Address - Fax:
Practice Address - Street 1:117 N SAN MATEO DR STE 1
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2794
Practice Address - Country:US
Practice Address - Phone:650-425-9408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA130632207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine