Healthcare Provider Details

I. General information

NPI: 1326632951
Provider Name (Legal Business Name): KAITLYN KUO AND ASSOCIATES PSYCHOLOGY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 S COAST HWY STE 1493
LAGUNA BEACH CA
92651-3681
US

IV. Provider business mailing address

1968 S COAST HWY STE 1493
LAGUNA BEACH CA
92651-3681
US

V. Phone/Fax

Practice location:
  • Phone: 949-229-1314
  • Fax:
Mailing address:
  • Phone: 949-229-1314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHAO CHIN KUO
Title or Position: DIRECTOR
Credential: PSYD
Phone: 949-229-1314