MEDICARE: WAN YEE LO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1033709704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAN YEE LO

Provider Business Mailing Address
First Line	:	1957 E 29TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2534
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1957 E 29TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2534
Country	:	US
Telephone Number	:	718-838-8666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2021
Last Update Date	:	01/26/2021

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Directions to “ WAN YEE LO ” Practice Location

Language	Start Address	Practice Location

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