Healthcare Provider Details

I. General information

NPI: 1811301625
Provider Name (Legal Business Name): KEVIN KUO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 W HILLSBOROUGH AVE # 148
TAMPA FL
33615-3810
US

IV. Provider business mailing address

8635 W HILLSBOROUGH AVE # 148
TAMPA FL
33615-3810
US

V. Phone/Fax

Practice location:
  • Phone: 734-707-1505
  • Fax:
Mailing address:
  • Phone: 734-707-1505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN1856948
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN24570
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: