Healthcare Provider Details

I. General information

NPI: 1265777684
Provider Name (Legal Business Name): JONATHAN KUO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 SAN PABLO ST STE 3000
LOS ANGELES CA
90033-5315
US

IV. Provider business mailing address

PO BOX 31309
LOS ANGELES CA
90031-0309
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-5710
  • Fax: 323-442-7978
Mailing address:
  • Phone: 323-442-5710
  • Fax: 323-442-7978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA116635
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License NumberA116635
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: