Provider Demographics
NPI:1811007164
Name:EDMUND LO MD INC
Entity type:Organization
Organization Name:EDMUND LO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDMUND
Authorized Official - Middle Name:
Authorized Official - Last Name:LO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-284-2264
Mailing Address - Street 1:123 N GARFIELD AVE
Mailing Address - Street 2:#A
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801
Mailing Address - Country:US
Mailing Address - Phone:626-284-2264
Mailing Address - Fax:626-284-5457
Practice Address - Street 1:123 N GARFIELD AVE
Practice Address - Street 2:#A
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801
Practice Address - Country:US
Practice Address - Phone:626-284-2264
Practice Address - Fax:626-284-5457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63461207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0092760Medicaid
W15540Medicare ID - Type Unspecified
CAGR0092760Medicaid