Healthcare Provider Details

I. General information

NPI: 1205358264
Provider Name (Legal Business Name): HARRY LOO MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2796 SYCAMORE DR STE 101
SIMI VALLEY CA
93065-1549
US

IV. Provider business mailing address

2796 SYCAMORE DR STE 101
SIMI VALLEY CA
93065-1549
US

V. Phone/Fax

Practice location:
  • Phone: 805-522-7955
  • Fax: 805-522-8272
Mailing address:
  • Phone: 805-522-7955
  • Fax: 805-522-8272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG29817
License Number StateCA

VIII. Authorized Official

Name: DR. HARRY LOO
Title or Position: PRESIDENT
Credential: MD
Phone: 805-522-7955