Healthcare Provider Details

I. General information

NPI: 1003859059
Provider Name (Legal Business Name): PHILIP IEE-LIAN KUO M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 12/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 ULUNIU ST
KAILUA HI
96734-2517
US

IV. Provider business mailing address

414 ULUNIU ST
KAILUA HI
96734-2517
US

V. Phone/Fax

Practice location:
  • Phone: 808-261-8345
  • Fax: 808-262-5239
Mailing address:
  • Phone: 808-261-8345
  • Fax: 808-262-5239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD12315
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD12315
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberMD12315
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: