Healthcare Provider Details

I. General information

NPI: 1023438785
Provider Name (Legal Business Name): SANDY KUO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 PALO VERDE AVE # 102
LONG BEACH CA
90815-1552
US

IV. Provider business mailing address

2921 PALO VERDE AVE STE 102
LONG BEACH CA
90815-1552
US

V. Phone/Fax

Practice location:
  • Phone: 562-999-3483
  • Fax: 562-262-2215
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberA138195
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number138192
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: