Provider Demographics
NPI:1013139831
Name:LO, AGNES CHINGTUEN
Entity Type:Individual
Prefix:MRS
First Name:AGNES
Middle Name:CHINGTUEN
Last Name:LO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4721 LE BEAU CT
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-2506
Mailing Address - Country:US
Mailing Address - Phone:510-793-7963
Mailing Address - Fax:
Practice Address - Street 1:34400 MISSION BLVD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-3604
Practice Address - Country:US
Practice Address - Phone:510-429-6472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA560174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist