Provider Demographics
NPI:1730972571
Name:LO, SIERRA KANAMI (OD)
Entity type:Individual
Prefix:DR
First Name:SIERRA
Middle Name:KANAMI
Last Name:LO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 OAK KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-3013
Mailing Address - Country:US
Mailing Address - Phone:626-733-1827
Mailing Address - Fax:
Practice Address - Street 1:451 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-3363
Practice Address - Country:US
Practice Address - Phone:626-912-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-24
Last Update Date:2025-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program