Healthcare Provider Details

I. General information

NPI: 1659952968
Provider Name (Legal Business Name): WESLEY KUO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3975 OLD REDWOOD HWY STE 152
SANTA ROSA CA
95403-1719
US

IV. Provider business mailing address

3975 OLD REDWOOD HWY STE 152
SANTA ROSA CA
95403-1719
US

V. Phone/Fax

Practice location:
  • Phone: 707-566-5557
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number20A25495
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number20A25495
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number20A25495
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: