Healthcare Provider Details

I. General information

NPI: 1871755017
Provider Name (Legal Business Name): JON WARREN LOO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24451 HEALTH CENTER DR
LAGUNA HILLS CA
92653-3689
US

IV. Provider business mailing address

28081 MARGUERITE PKWY UNIT 4433
MISSION VIEJO CA
92690-1916
US

V. Phone/Fax

Practice location:
  • Phone: 949-452-3573
  • Fax:
Mailing address:
  • Phone: 414-704-8106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA123551
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberPG167394
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: