Healthcare Provider Details

I. General information

NPI: 1568597607
Provider Name (Legal Business Name): CANDACE Y KUO O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 W DANA ST
MOUNTAIN VIEW CA
94041-1219
US

IV. Provider business mailing address

11090 MORA DR
LOS ALTOS CA
94024-6534
US

V. Phone/Fax

Practice location:
  • Phone: 650-305-9328
  • Fax:
Mailing address:
  • Phone: 650-305-9328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT11679T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: