Healthcare Provider Details

I. General information

NPI: 1770018640
Provider Name (Legal Business Name): KATHLEEN LO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14651 S BASCOM AVE STE 110
LOS GATOS CA
95032-2004
US

IV. Provider business mailing address

14651 S BASCOM AVE STE 110
LOS GATOS CA
95032-2004
US

V. Phone/Fax

Practice location:
  • Phone: 408-358-3573
  • Fax:
Mailing address:
  • Phone: 408-358-3573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberA157577
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA157577
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: