Healthcare Provider Details

I. General information

NPI: 1902930092
Provider Name (Legal Business Name): CHRISTINE KUO PSY D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31824 VILLAGE CENTER RD STE F
WESTLAKE VILLAGE CA
91361-4339
US

IV. Provider business mailing address

PO BOX 2843
MALIBU CA
90265-7843
US

V. Phone/Fax

Practice location:
  • Phone: 818-991-1063
  • Fax: 818-991-1064
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPSB31040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: