Healthcare Provider Details

I. General information

NPI: 1861997819
Provider Name (Legal Business Name): YU CHENG GEORGE KUO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 W FREMONT AVE STE S
SUNNYVALE CA
94087-3065
US

IV. Provider business mailing address

16411 NE 20TH ST
BELLEVUE WA
98008-2603
US

V. Phone/Fax

Practice location:
  • Phone: 408-736-4101
  • Fax:
Mailing address:
  • Phone: 425-503-9208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number103863
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: