Healthcare Provider Details

I. General information

NPI: 1083013288
Provider Name (Legal Business Name): DAVID TE FU KUO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 S SAN GABRIEL BLVD
SAN GABRIEL CA
91776-2743
US

IV. Provider business mailing address

1604 HILLIARD DR
SAN MARINO CA
91108-3008
US

V. Phone/Fax

Practice location:
  • Phone: 626-872-0738
  • Fax:
Mailing address:
  • Phone: 626-451-0332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number34983
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: