Provider Demographics
NPI:1881858199
Name:LO, CHIA-YIN (CHIA-YIN LO)
Entity Type:Individual
Prefix:
First Name:CHIA-YIN
Middle Name:
Last Name:LO
Suffix:
Gender:F
Credentials:CHIA-YIN LO
Other - Prefix:
Other - First Name:CHIA-YIN
Other - Middle Name:
Other - Last Name:LO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:215 OAK GROVE ST APT 608
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:ONE VETERANS DRIVE 160
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417
Practice Address - Country:US
Practice Address - Phone:612-467-4070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12248122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist