Healthcare Provider Details

I. General information

NPI: 1427192145
Provider Name (Legal Business Name): MEI-WEN KUO D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4194 CONVOY ST
SAN DIEGO CA
92111-3702
US

IV. Provider business mailing address

12501 DORMOUSE RD
SAN DIEGO CA
92129-4506
US

V. Phone/Fax

Practice location:
  • Phone: 858-569-1918
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number47504
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: