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General NPI Number Information
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NPI Number | 1710278536
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Entity Type | Organization
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Legal Business Name | LAWRENCE Y LO MD INC
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Dates
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Enumeration Date | 04/27/2011
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Last Update Date | 04/27/2011
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Provider Practice Location Address
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Address Line | 400 NEWPORT CENTER DR STE 301
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7604
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Country | US
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Telephone | 949-644-1300
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Fax |
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Provider Business Mailing Address
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Address Line | 400 NEWPORT CENTER DR STE 301
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7604
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Country | US
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Telephone | 949-644-1300
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAWRENCE YINTSUN LO
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Credential | M.D.
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Telephone | 949-644-1300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | C41211
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License Number State | CA
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