Healthcare Provider Details

I. General information

NPI: 1093734568
Provider Name (Legal Business Name): LING LO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19671 BEACH BLVD STE 315
HUNTINGTON BEACH CA
92648-5904
US

IV. Provider business mailing address

PO BOX 512185
LOS ANGELES CA
90051-0185
US

V. Phone/Fax

Practice location:
  • Phone: 714-252-9415
  • Fax: 714-963-8407
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number17780
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: