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General NPI Number Information
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NPI Number | 1740422773
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Entity Type | Organization
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Legal Business Name | JAYSON LO, D.M.D., INC.
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Dates
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Enumeration Date | 04/06/2009
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Last Update Date | 04/06/2009
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Provider Practice Location Address
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Address Line | 341 WESTLAKE CTR SUITE 301
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City | DALY CITY
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State | CA
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Zip | 94015-1441
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Country | US
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Telephone | 650-293-7722
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Fax |
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Provider Business Mailing Address
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Address Line | 341 WESTLAKE CTR SUITE 301
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City | DALY CITY
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State | CA
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Zip | 94015-1441
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Country | US
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Telephone | 650-293-7722
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAYSON LO
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Credential | D.M.D.
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Telephone | 650-293-7722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 57177
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License Number State | CA
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