Healthcare Provider Details

I. General information

NPI: 1760907976
Provider Name (Legal Business Name): CHRISTINA SOPHIA KUO MMS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27300 IRIS AVE
MORENO VALLEY CA
92555
US

IV. Provider business mailing address

27300 IRIS AVE
MORENO VALLEY CA
92555-4802
US

V. Phone/Fax

Practice location:
  • Phone: 951-251-6565
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number54726
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: