Provider Demographics
NPI: | 1720161854 |
---|---|
Name: | LO, DAVID YUNG-AN (MD) |
Entity type: | Individual |
Prefix: | DR |
First Name: | DAVID |
Middle Name: | YUNG-AN |
Last Name: | LO |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 3400 OLENTANGY RIVER RD |
Mailing Address - Street 2: | |
Mailing Address - City: | COLUMBUS |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 43202-1523 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 614-754-5500 |
Mailing Address - Fax: | 614-457-9519 |
Practice Address - Street 1: | 3400 OLENTANGY RIVER RD |
Practice Address - Street 2: | |
Practice Address - City: | COLUMBUS |
Practice Address - State: | OH |
Practice Address - Zip Code: | 43202-1523 |
Practice Address - Country: | US |
Practice Address - Phone: | 614-754-5500 |
Practice Address - Fax: | 614-457-9519 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-10-23 |
Last Update Date: | 2023-11-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MO | 2006024361 | 207R00000X |
ME | EC101065 | 207RG0100X |
OH | 35097183 | 207RG0100X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 0053892 | Medicaid | |
OH | H005640 | Medicare PIN |