Healthcare Provider Details

I. General information

NPI: 1477642510
Provider Name (Legal Business Name): SU-MUI KUO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 PACIFIC AVE. SUITE # 406
SAN FRANCISCO CA
94133-4457
US

IV. Provider business mailing address

728 PACIFIC AVE SUITE # 406
SAN FRANCISCO CA
94133-4457
US

V. Phone/Fax

Practice location:
  • Phone: 415-393-6500
  • Fax: 415-393-6506
Mailing address:
  • Phone: 415-393-6500
  • Fax: 415-393-6506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA36124
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: