Healthcare Provider Details

I. General information

NPI: 1619972700
Provider Name (Legal Business Name): JOHN-CHARLES AIONA LOO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 12/03/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ATLANTIC AVE 3RD FLOOR PEDIATRICS
LONG BEACH CA
90806-1701
US

IV. Provider business mailing address

3080 BRISTOL ST STE 600
COSTA MESA CA
92626-3093
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-3350
  • Fax: 562-933-3359
Mailing address:
  • Phone: 714-445-0220
  • Fax: 714-445-0245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberA67200
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: