Healthcare Provider Details

I. General information

NPI: 1861569436
Provider Name (Legal Business Name): SU YONG KUO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 WARNER AVE #154
FOUNTAIN VALLEY CA
92708
US

IV. Provider business mailing address

11100 WARNER AVE #154
FOUNTAIN VALLEY CA
92708
US

V. Phone/Fax

Practice location:
  • Phone: 714-545-9110
  • Fax: 714-545-1891
Mailing address:
  • Phone: 714-545-9110
  • Fax: 714-545-1891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA32308
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: