Healthcare Provider Details

I. General information

NPI: 1972740744
Provider Name (Legal Business Name): ERIC YEN-MING LOO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33608 ORTEGA HWY BLDG A
SAN JUAN CAPISTRANO CA
92675-2042
US

IV. Provider business mailing address

33608 ORTEGA HWY BLDG A
SAN JUAN CAPISTRANO CA
92675-2042
US

V. Phone/Fax

Practice location:
  • Phone: 949-728-4155
  • Fax:
Mailing address:
  • Phone: 949-728-4155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number17115
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberA105865
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number17115
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License NumberRS2014-0413
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number17115
License Number StateNH
# 6
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA105865
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: