Healthcare Provider Details

I. General information

NPI: 1750838249
Provider Name (Legal Business Name): YUNG JEN KUO FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 11/22/2025
Certification Date: 11/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 W FOOTHILL BLVD STE 209
UPLAND CA
91786-3806
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 909-982-4000
  • Fax:
Mailing address:
  • Phone: 702-579-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95004754
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: