Provider Demographics
NPI:1306065479
Name:LO, KATHY KAI YEE (MD)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:KAI YEE
Last Name:LO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1110 MEADE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512-3169
Mailing Address - Country:US
Mailing Address - Phone:570-504-7210
Mailing Address - Fax:570-955-2213
Practice Address - Street 1:89 SPARTA AVE
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1777
Practice Address - Country:US
Practice Address - Phone:973-729-7001
Practice Address - Fax:973-729-0256
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA081976002085R0001X
PAMD 4313322085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02928687Medicaid
NJ0143481Medicaid
PA101976050Medicaid
NY02928687Medicaid
PA101976050Medicaid
NJ111925Medicare PIN