Provider Demographics
NPI:1942314059
Name:LOH, INKYU (MD)
Entity Type:Individual
Prefix:
First Name:INKYU
Middle Name:
Last Name:LOH
Suffix:
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 1:32 KENT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7902
Mailing Address - Country:US
Mailing Address - Phone:617-383-6405
Mailing Address - Fax:617-383-6404
Practice Address - Street 1:32 KENT ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7902
Practice Address - Country:US
Practice Address - Phone:617-383-6405
Practice Address - Fax:617-383-6404
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209119207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2116456Medicaid
MA2116456Medicaid
A39739Medicare PIN