Healthcare Provider Details

I. General information

NPI: 1851520738
Provider Name (Legal Business Name): EDDIE KUO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 NORTH BRIDGE STREET
VISALIA CA
93291-5014
US

IV. Provider business mailing address

314 NORTH MAIN STREET
PORTERVILLE CA
93257-3730
US

V. Phone/Fax

Practice location:
  • Phone: 559-734-1939
  • Fax: 559-734-4384
Mailing address:
  • Phone: 559-791-7000
  • Fax: 559-782-1418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number987654321
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number58718
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: