Provider Demographics
NPI:1811180953
Name:LO, EDMUND (MD)
Entity type:Individual
Prefix:
First Name:EDMUND
Middle Name:
Last Name:LO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 N GARFIELD AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3564
Mailing Address - Country:US
Mailing Address - Phone:626-284-2264
Mailing Address - Fax:626-284-5457
Practice Address - Street 1:123 N GARFIELD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3564
Practice Address - Country:US
Practice Address - Phone:626-284-2264
Practice Address - Fax:626-284-5457
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63461207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G634610Medicaid
CAWG63461BMedicare PIN
CA00G634610Medicaid