Healthcare Provider Details

I. General information

NPI: 1518485937
Provider Name (Legal Business Name): SUYEU KUO PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7817 HERSCHEL AVE # 101-102
LA JOLLA CA
92037-4454
US

IV. Provider business mailing address

PO BOX 12589
PLEASANTON CA
94588-2589
US

V. Phone/Fax

Practice location:
  • Phone: 925-269-7451
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number33714
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: