Healthcare Provider Details

I. General information

NPI: 1043402332
Provider Name (Legal Business Name): DR. CAROLINE YI-SHOO KUO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLINE KUO M.D.

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10833 LE CONTE AVE
LOS ANGELES CA
90095-2004
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-1826
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number105714
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: