MEDICARE: TOM KUO M.D.

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	207P00000X	Emergency Medicine Physician	A91444	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	W14560F	OTHER	CA	GROUP MEDICARE ID NUMBER

General Provider Information

NPI Number	:	1811936123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOM KUO M.D.

Provider Business Mailing Address
First Line	:	3713 COOLIDGE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-3311
Country	:	US
Telephone Number	:	714-362-1748
Fax Number	:

Provider Business Practice Location Address
First Line	:	4560 ADMIRALTY WAY
Second Line	:	SUITE 100
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-5423
Country	:	US
Telephone Number	:	310-827-3700
Fax Number	:	310-578-5379

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	03/05/2014

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Directions to “ TOM KUO M.D.” Practice Location

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