Healthcare Provider Details

I. General information

NPI: 1922105972
Provider Name (Legal Business Name): DAVID KUO D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 GRANT ST
EVANSTON IL
60201-1903
US

IV. Provider business mailing address

1921 LAKE AVE STE B
WILMETTE IL
60091-1480
US

V. Phone/Fax

Practice location:
  • Phone: 847-853-9100
  • Fax: 847-853-9103
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number036062521
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: