Basic Information
| Provider Information | |||||||||
| NPI: | 1144621160 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LO | ||||||||
| FirstName: | KAI | ||||||||
| MiddleName: | HANG | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12017 SANDY RIVER CT | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933119312 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 420 34TH ST | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933012237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613274647 | ||||||||
| FaxNumber: | 6613950965 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2014 | ||||||||
| LastUpdateDate: | 09/09/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 53403 | CA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.