Healthcare Provider Details

I. General information

NPI: 1508991308
Provider Name (Legal Business Name): THOMAS R KUO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 SO OXFORD AVE STE#101
LOS ANGELES CA
90004
US

IV. Provider business mailing address

258 SO OXFORD AVE STE#101
LOS ANGELES CA
90004
US

V. Phone/Fax

Practice location:
  • Phone: 213-385-8242
  • Fax: 213-385-9499
Mailing address:
  • Phone: 213-385-8242
  • Fax: 213-385-9499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number25733
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: