Healthcare Provider Details

I. General information

NPI: 1366311953
Provider Name (Legal Business Name): WILLIAM KUO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 RAVENNA TER
FREMONT CA
94536-3281
US

IV. Provider business mailing address

618 RAVENNA TER
FREMONT CA
94536-3281
US

V. Phone/Fax

Practice location:
  • Phone: 510-284-9820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: