Basic Information
| Provider Information | |||||||||
| NPI: | 1740667526 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LO | ||||||||
| FirstName: | JUSTIN | ||||||||
| MiddleName: | SZE-CHUNG | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5740 SOUTHWOOD DR | ||||||||
| Address2: | |||||||||
| City: | LAKE OSWEGO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970356736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035399132 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1111 E MCDOWELL RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850062612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805002540 | ||||||||
| FaxNumber: | 6232017954 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2015 | ||||||||
| LastUpdateDate: | 07/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | OP61155048 | WA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | 007900 | AZ | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.