MEDICARE: SUMMIT FAMILY HEALTH CENTER OF SHERMAN OAKS

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	FNP 1841	CA

General Provider Information

NPI Number	:	1952557050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT FAMILY HEALTH CENTER OF SHERMAN OAKS

Provider Business Mailing Address
First Line	:	4849 VAN NUYS BLVD
Second Line	:	SUITE 200
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-2110
Country	:	US
Telephone Number	:	818-788-5788
Fax Number	:	818-981-9884

Provider Business Practice Location Address
First Line	:	4849 VAN NUYS BLVD
Second Line	:	SUITE 200
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-2110
Country	:	US
Telephone Number	:	818-788-5788
Fax Number	:	818-981-9884

Authorized Official
Title or Position	:	CEO
Name	:	DR. SIANG LIAN LO
Credential	:	D.O.
Telephone Number	:	818-468-2098

Provider Enumeration Date	:	08/08/2008
Last Update Date	:	09/15/2008

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