Healthcare Provider Details

I. General information

NPI: 1588831309
Provider Name (Legal Business Name): MYRNA IEE-HSIN KUO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 12/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1427 CAMDEN AVE UNIT 102
LOS ANGELES CA
90025-8033
US

IV. Provider business mailing address

1427 CAMDEN AVE APT UNIT102
LOS ANGELES CA
90025-8033
US

V. Phone/Fax

Practice location:
  • Phone: 808-523-1600
  • Fax: 808-526-0221
Mailing address:
  • Phone: 808-523-1600
  • Fax: 808-526-0221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number14712
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: