Healthcare Provider Details

I. General information

NPI: 1689140550
Provider Name (Legal Business Name): KEVIN YUCHUN KUO PHARMD, RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 EASTBLUFF DR
NEWPORT BEACH CA
92660-3504
US

IV. Provider business mailing address

11 PAMLICO
IRVINE CA
92620-2729
US

V. Phone/Fax

Practice location:
  • Phone: 949-812-9597
  • Fax:
Mailing address:
  • Phone: 949-812-9597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number79156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: