Provider Demographics
NPI:1821146606
Name:LO, SIANG L (DO)
Entity Type:Individual
Prefix:
First Name:SIANG
Middle Name:L
Last Name:LO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950
Mailing Address - Country:US
Mailing Address - Phone:831-649-1011
Mailing Address - Fax:831-373-8201
Practice Address - Street 1:621 FOREST AVE
Practice Address - Street 2:
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-4264
Practice Address - Country:US
Practice Address - Phone:831-649-1011
Practice Address - Fax:831-373-8201
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A6730207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAQ033ZMedicare PIN