Healthcare Provider Details

I. General information

NPI: 1831182146
Provider Name (Legal Business Name): JONG YUAN KUO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MACARTHUR BLVD MUNSTER RADIOLOGY GROUP
MUNSTER IN
46321-2901
US

IV. Provider business mailing address

9201 CALUMET AVE
MUNSTER IN
46321-2807
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-4569
  • Fax:
Mailing address:
  • Phone: 219-836-2022
  • Fax: 219-836-0034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number01038120A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01038120A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: