Healthcare Provider Details

I. General information

NPI: 1811936123
Provider Name (Legal Business Name): TOM KUO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 03/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4560 ADMIRALTY WAY SUITE 100
MARINA DEL REY CA
90292-5423
US

IV. Provider business mailing address

3713 COOLIDGE AVE
LOS ANGELES CA
90066-3311
US

V. Phone/Fax

Practice location:
  • Phone: 310-827-3700
  • Fax: 310-578-5379
Mailing address:
  • Phone: 714-362-1748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA91444
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: