Healthcare Provider Details

I. General information

NPI: 1417278565
Provider Name (Legal Business Name): ENID TAMI KUO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 12/06/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 W SUNSET BLVD FL 5 DEPT OB/GYN
LOS ANGELES CA
90027-5814
US

IV. Provider business mailing address

4900 W SUNSET BLVD FL 5 DEPT OB/GYN
LOS ANGELES CA
90027-5814
US

V. Phone/Fax

Practice location:
  • Phone: 323-783-9421
  • Fax:
Mailing address:
  • Phone: 323-783-9421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA107937
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: