Healthcare Provider Details

I. General information

NPI: 1922033620
Provider Name (Legal Business Name): RAYMOND H. KUO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 S MAIN ST
ORANGE CA
92868-3851
US

IV. Provider business mailing address

1516 COTNER AVE
LOS ANGELES CA
90025-3303
US

V. Phone/Fax

Practice location:
  • Phone: 714-978-2937
  • Fax: 714-978-2518
Mailing address:
  • Phone: 310-445-2951
  • Fax: 310-479-1459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA78920
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: