Provider Demographics
NPI:1538184957
Name:ITO, LLOYD K (MD)
Entity type:Individual
Prefix:
First Name:LLOYD
Middle Name:K
Last Name:ITO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10515 BALBOA BLVD
Mailing Address - Street 2:SUITE 325
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6343
Mailing Address - Country:US
Mailing Address - Phone:818-366-0565
Mailing Address - Fax:818-366-6383
Practice Address - Street 1:10515 BALBOA BLVD
Practice Address - Street 2:SUITE 325
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6343
Practice Address - Country:US
Practice Address - Phone:818-366-0565
Practice Address - Fax:818-366-6383
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG51268207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G512681Medicaid
CA00G512681Medicaid
G51268Medicare PIN