Healthcare Provider Details

I. General information

NPI: 1962907014
Provider Name (Legal Business Name): ERIC JIA-YOUNG KUO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 S SAN MATEO DR
SAN MATEO CA
94401-3857
US

IV. Provider business mailing address

325 DISTEL CIR
LOS ALTOS CA
94022-1408
US

V. Phone/Fax

Practice location:
  • Phone: 650-696-5420
  • Fax:
Mailing address:
  • Phone: 650-696-5420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA163941
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: