Healthcare Provider Details

I. General information

NPI: 1518321611
Provider Name (Legal Business Name): CARLA KUO L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 ILIMA PL
HILO HI
96720-1728
US

IV. Provider business mailing address

13 ILIMA PL
HILO HI
96720-1728
US

V. Phone/Fax

Practice location:
  • Phone: 808-218-9234
  • Fax:
Mailing address:
  • Phone: 808-218-9234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number800
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: