Healthcare Provider Details

I. General information

NPI: 1316080344
Provider Name (Legal Business Name): TRACY F KUO PHD, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 01/20/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 MACARTHUR BLVD STE 600
NEWPORT BEACH CA
92660-2517
US

IV. Provider business mailing address

4000 MACARTHUR BLVD STE 600
NEWPORT BEACH CA
92660-2517
US

V. Phone/Fax

Practice location:
  • Phone: 949-385-2020
  • Fax: 949-251-1102
Mailing address:
  • Phone: 949-385-2020
  • Fax: 949-251-1102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number18251
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number18251
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number18251
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number18251
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number18251
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95062109
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number552530
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code173F00000X
TaxonomySleep Specialist (PhD)
License Number18251
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95006517
License Number StateCA
# 10
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95006517
License Number StateCA
# 11
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95006517
License Number StateCA
# 12
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number18251
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: