Healthcare Provider Details

I. General information

NPI: 1053473728
Provider Name (Legal Business Name): ALVIN KWAN YANG LO O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17110 COLIMA RD STE F
HACIENDA HEIGHTS CA
91745-6786
US

IV. Provider business mailing address

17110 COLIMA RD STE F
HACIENDA HEIGHTS CA
91745-6786
US

V. Phone/Fax

Practice location:
  • Phone: 626-912-3937
  • Fax: 626-469-4949
Mailing address:
  • Phone: 626-912-3937
  • Fax: 626-469-4949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9910T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: