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General NPI Number Information
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NPI Number | 1740667526
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Entity Type | Individual
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Provider Name | JUSTIN SZE-CHUNG LO D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/30/2015
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Last Update Date | 07/13/2022
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Provider Practice Location Address
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Address Line | 1111 E MCDOWELL RD
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City | PHOENIX
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State | AZ
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Zip | 85006-2612
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Country | US
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Telephone | 480-500-2540
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Fax | 623-201-7954
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Provider Business Mailing Address
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Address Line | 5740 SOUTHWOOD DR
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-6736
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Country | US
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Telephone | 503-539-9132
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | OP61155048
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 007900
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License Number State | AZ
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