Healthcare Provider Details

I. General information

NPI: 1609241314
Provider Name (Legal Business Name): SHYH-SHIAW KUO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2015
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21710 STEVENS CREEK BLVD STE 105
CUPERTINO CA
95014-1179
US

IV. Provider business mailing address

21710 STEVENS CREEK BLVD STE 105
CUPERTINO CA
95014-1179
US

V. Phone/Fax

Practice location:
  • Phone: 408-458-5256
  • Fax:
Mailing address:
  • Phone: 408-458-5256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number100408
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: