Basic Information
| Provider Information | |||||||||
| NPI: | 1083956213 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LO | ||||||||
| FirstName: | IRENE | ||||||||
| MiddleName: | JIA-SHIN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 LA CASA VIA | ||||||||
| Address2: | BUILDING 3, SUITE 211 | ||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945983045 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 130 LA CASA VIA | ||||||||
| Address2: | BUILDING 3, SUITE 211 | ||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945983045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259330984 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2013 | ||||||||
| LastUpdateDate: | 06/10/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | A125005 | CA | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.