Healthcare Provider Details

I. General information

NPI: 1215128038
Provider Name (Legal Business Name): TIN-YUAN LO HUANG O.T.R.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 WESTWIND DR
TUSTIN CA
92782-6528
US

IV. Provider business mailing address

240 WESTWIND DR
TUSTIN CA
92782-6528
US

V. Phone/Fax

Practice location:
  • Phone: 949-733-1841
  • Fax:
Mailing address:
  • Phone: 949-733-1841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3722
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: