Healthcare Provider Details

I. General information

NPI: 1568404655
Provider Name (Legal Business Name): TONY I KUO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 NEWPORT BLVD SUITE 208
COSTA MESA CA
92627-2278
US

IV. Provider business mailing address

1901 NEWPORT BLVD SUITE 208
COSTA MESA CA
92627-2278
US

V. Phone/Fax

Practice location:
  • Phone: 949-650-5068
  • Fax: 949-650-0334
Mailing address:
  • Phone: 949-650-5068
  • Fax: 949-650-0334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number47380
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: