Provider Demographics
NPI:1245485713
Name:LO, CHUTARAT (DDS)
Entity type:Individual
Prefix:DR
First Name:CHUTARAT
Middle Name:
Last Name:LO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5327 MYRTUS AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-3614
Mailing Address - Country:US
Mailing Address - Phone:626-485-1756
Mailing Address - Fax:
Practice Address - Street 1:7285 QUILL DR
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2001
Practice Address - Country:US
Practice Address - Phone:626-485-1756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA289941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice