Provider Demographics
NPI:1790742856
Name:LO, ABRAHAM JOHN ABAD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ABRAHAM JOHN
Middle Name:ABAD
Last Name:LO
Suffix:JR
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 1:75036 GERALD FORD DR
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-2080
Mailing Address - Country:US
Mailing Address - Phone:760-877-1791
Mailing Address - Fax:
Practice Address - Street 1:75036 GERALD FORD DR
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-2080
Practice Address - Country:US
Practice Address - Phone:760-877-1791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53654174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G14826Medicare UPIN
00A536540Medicare ID - Type Unspecified