MEDICARE: LAWRENCE Y LO MD INC

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	261QP2300X	Primary Care Clinic/Center	C41211	CA

General Provider Information

NPI Number	:	1710278536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWRENCE Y LO MD INC

Provider Business Mailing Address
First Line	:	400 NEWPORT CENTER DR STE 301
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-7604
Country	:	US
Telephone Number	:	949-644-1300
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 NEWPORT CENTER DR STE 301
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-7604
Country	:	US
Telephone Number	:	949-644-1300
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LAWRENCE YINTSUN LO
Credential	:	M.D.
Telephone Number	:	949-644-1300

Provider Enumeration Date	:	04/27/2011
Last Update Date	:	04/27/2011

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