Healthcare Provider Details

I. General information

NPI: 1942994751
Provider Name (Legal Business Name): ELLEN GRACE KUO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 E CESAR E CHAVEZ AVE
LOS ANGELES CA
90033-2414
US

IV. Provider business mailing address

2325 TALAVERA DR
SAN RAMON CA
94583-2230
US

V. Phone/Fax

Practice location:
  • Phone: 323-260-5810
  • Fax: 323-881-8601
Mailing address:
  • Phone: 925-786-0673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: