Provider Demographics
NPI:1811978604
Name:LO, CHARLES YIN-YAT (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:YIN-YAT
Last Name:LO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:818 JACKSON ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-4849
Mailing Address - Country:US
Mailing Address - Phone:415-391-9993
Mailing Address - Fax:415-291-9993
Practice Address - Street 1:818 JACKSON STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-4849
Practice Address - Country:US
Practice Address - Phone:415-391-9993
Practice Address - Fax:415-291-9993
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA00A519440208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A519440Medicaid
CAG53345Medicare UPIN
CA00A519440Medicaid