Healthcare Provider Details

I. General information

NPI: 1861608358
Provider Name (Legal Business Name): ELISA LING KUO D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 9TH ST SUITE 401
OAKLAND CA
94607-6514
US

IV. Provider business mailing address

373 9TH ST SUITE 401
OAKLAND CA
94607-6514
US

V. Phone/Fax

Practice location:
  • Phone: 510-834-4640
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number50153
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: