Healthcare Provider Details

I. General information

NPI: 1841295961
Provider Name (Legal Business Name): DAVID WAYNE KUO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 S EL MOLINO AVE STE 301
PASADENA CA
91101-2562
US

IV. Provider business mailing address

151 S EL MOLINO AVE STE 301
PASADENA CA
91101-2562
US

V. Phone/Fax

Practice location:
  • Phone: 626-449-0510
  • Fax: 626-449-1640
Mailing address:
  • Phone: 626-449-0510
  • Fax: 626-449-1640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number24460
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: