Provider Demographics
NPI:1730341686
Name:LO, KUON S (MD)
Entity type:Individual
Prefix:DR
First Name:KUON
Middle Name:S
Last Name:LO
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 1:1100 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-5520
Mailing Address - Country:US
Mailing Address - Phone:617-696-3800
Mailing Address - Fax:617-696-3811
Practice Address - Street 1:1100 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124
Practice Address - Country:US
Practice Address - Phone:617-696-3800
Practice Address - Fax:617-696-3811
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA253644207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110094150AMedicaid
MA110094150AMedicaid