Healthcare Provider Details

I. General information

NPI: 1184012932
Provider Name (Legal Business Name): MEE YOW LOH RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2015
Last Update Date: 01/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 168TH AVENUE
SAN LEANDRO CA
94578
US

IV. Provider business mailing address

1440 168TH AVE
SAN LEANDRO CA
94578-2409
US

V. Phone/Fax

Practice location:
  • Phone: 510-481-6319
  • Fax: 510-481-6310
Mailing address:
  • Phone: 510-481-6319
  • Fax: 510-481-6310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code132700000X
TaxonomyDietary Manager
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: