Provider Demographics
NPI:1295948776
Name:LO, CHESTER CHINKANG (DPM)
Entity type:Individual
Prefix:DR
First Name:CHESTER
Middle Name:CHINKANG
Last Name:LO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1108
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-0866
Mailing Address - Country:US
Mailing Address - Phone:212-233-9400
Mailing Address - Fax:212-608-1828
Practice Address - Street 1:198 CANAL ST
Practice Address - Street 2:SUITE 302
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4531
Practice Address - Country:US
Practice Address - Phone:212-233-9400
Practice Address - Fax:212-608-1828
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003582213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00801414Medicaid
NY00801414Medicaid
NYP37291Medicare ID - Type Unspecified