Basic Information
Provider Information
NPI: 1275727349
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LO
FirstName: HUILING
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2215 INDIAN CREEK RD
Address2:  
City: DIAMOND BAR
State: CA
PostalCode: 917653348
CountryCode: US
TelephoneNumber: 6265761049
FaxNumber:  
Practice Location
Address1: 401 S AZUSA AVE # A
Address2:  
City: LA PUENTE
State: CA
PostalCode: 917445111
CountryCode: US
TelephoneNumber: 6268108222
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/31/2007
LastUpdateDate: 02/23/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000X56181CAY Dental ProvidersDentist 

No ID Information.


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