Healthcare Provider Details

I. General information

NPI: 1528171667
Provider Name (Legal Business Name): TONY YU HONG KUO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 COLORADO AVENUE
SANTA MONICA CA
90404
US

IV. Provider business mailing address

5767 W CENTURY BLVD SUITE 200
LOS ANGELES CA
90045-5632
US

V. Phone/Fax

Practice location:
  • Phone: 310-319-4700
  • Fax:
Mailing address:
  • Phone: 310-794-3219
  • Fax: 310-794-6097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA67011
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: