Healthcare Provider Details

I. General information

NPI: 1669834008
Provider Name (Legal Business Name): ENOCH KUO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ROLLINS ST
ORLANDO FL
32803-1248
US

IV. Provider business mailing address

PO BOX 919465
ORLANDO FL
32891-0001
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-7683
  • Fax: 407-303-7252
Mailing address:
  • Phone: 407-422-9831
  • Fax: 855-671-4753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME143483
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: