Provider Demographics
NPI:1891053187
Name:LO, SUNNY (DO)
Entity type:Individual
Prefix:
First Name:SUNNY
Middle Name:
Last Name:LO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 S GARFIELD AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4429
Mailing Address - Country:US
Mailing Address - Phone:818-659-5887
Mailing Address - Fax:701-409-2589
Practice Address - Street 1:612 W DUARTE RD STE 601
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-9240
Practice Address - Country:US
Practice Address - Phone:818-659-5887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A13069207RG0100X
CODR.0055419207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO497099YK2DMedicaid