MEDICARE: KENNETH YUEN-JING 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	225100000X	Physical Therapist	25223	CA

General Provider Information

NPI Number	:	1396382602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH YUEN-JING LO

Provider Business Mailing Address
First Line	:	5073 PIPER GLEN TER
Second Line	:
City	:	DUBLIN
State	:	CA
Zip	:	94568-7490
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5073 PIPER GLEN TER
Second Line	:
City	:	DUBLIN
State	:	CA
Zip	:	94568-7490
Country	:	US
Telephone Number	:	650-218-2542
Fax Number	:

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

Provider Enumeration Date	:	12/05/2019
Last Update Date	:	12/05/2019

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