Healthcare Provider Details

I. General information

NPI: 1215820550
Provider Name (Legal Business Name): KAYLYNN KUO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 PINE AVE STE 609
LONG BEACH CA
90802-2310
US

IV. Provider business mailing address

19816 FALCON CREST WAY
NORTHRIDGE CA
91326-4030
US

V. Phone/Fax

Practice location:
  • Phone: 310-571-5041
  • Fax:
Mailing address:
  • Phone: 206-940-8638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: