Healthcare Provider Details

I. General information

NPI: 1316056146
Provider Name (Legal Business Name): ALICE A KUO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10833 LE CONTE AVE 12-441 MDCC
LOS ANGELES CA
90095-3075
US

IV. Provider business mailing address

10833 LE CONTE AVE 12-441 MDCC
LOS ANGELES CA
90095-3075
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-3952
  • Fax: 310-206-0209
Mailing address:
  • Phone: 310-315-8900
  • Fax: 310-315-8902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA63708
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA63708
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: