Healthcare Provider Details

I. General information

NPI: 1992052567
Provider Name (Legal Business Name): JENNIFER KUO O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 10/17/2020
Certification Date: 10/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 SPEAR ST STE B11
SAN FRANCISCO CA
94105-1581
US

IV. Provider business mailing address

121 SPEAR ST STE B11
SAN FRANCISCO CA
94105-1581
US

V. Phone/Fax

Practice location:
  • Phone: 415-495-8600
  • Fax:
Mailing address:
  • Phone: 415-495-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number14485
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: