Healthcare Provider Details

I. General information

NPI: 1841267754
Provider Name (Legal Business Name): WAI KEUNG LOH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 E NORTHERN AVE SUITE 103
PHOENIX AZ
85020-3960
US

IV. Provider business mailing address

5810 E BERNEIL LN
PARADISE VALLEY AZ
85253-1734
US

V. Phone/Fax

Practice location:
  • Phone: 602-200-9021
  • Fax: 602-200-9087
Mailing address:
  • Phone: 480-296-5723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number19957
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: