MEDICARE: MRS. KAYING LO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320700000X	Physical Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1750681177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAYING LO

Provider Business Mailing Address
First Line	:	5938 E DAKOTA AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93727-7916
Country	:	US
Telephone Number	:	559-360-9736
Fax Number	:

Provider Business Practice Location Address
First Line	:	5938 E DAKOTA AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93727-7916
Country	:	US
Telephone Number	:	559-360-9736
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2010
Last Update Date	:	11/02/2010

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