Healthcare Provider Details

I. General information

NPI: 1962591990
Provider Name (Legal Business Name): JOHN KUO M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16055 VENTURA BLVD SUITE 700
ENCINO CA
91436
US

IV. Provider business mailing address

16055 VENTURA BLVD STE 700
ENCINO CA
91436-2638
US

V. Phone/Fax

Practice location:
  • Phone: 310-888-8448
  • Fax:
Mailing address:
  • Phone: 310-888-8448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberA79484
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: