Provider Demographics
NPI:1508807140
Name:LO, SHUYUN DAVID (MD)
Entity Type:Individual
Prefix:
First Name:SHUYUN
Middle Name:DAVID
Last Name:LO
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 1:1 WASHINGTON SQ
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95192-0037
Mailing Address - Country:US
Mailing Address - Phone:408-924-5919
Mailing Address - Fax:408-924-5933
Practice Address - Street 1:1 WASHINGTON SQ
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95192-0037
Practice Address - Country:US
Practice Address - Phone:408-924-5919
Practice Address - Fax:408-924-5933
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA602102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A602100Medicaid
CAA60210OtherMEDICAL LICENSE#
CAA60210OtherMEDICAL LICENSE#
CA00A602100Medicaid
CA00A602101Medicare ID - Type UnspecifiedMEDICARE#