Healthcare Provider Details

I. General information

NPI: 1558451914
Provider Name (Legal Business Name): PAUL C KUO M.D., D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 HARVARD ST SUITE 405
BROOKLINE MA
02446-5005
US

IV. Provider business mailing address

6 COUNTRY CLUB RD
NEWTON MA
02459-3065
US

V. Phone/Fax

Practice location:
  • Phone: 617-566-8800
  • Fax: 617-566-8818
Mailing address:
  • Phone: 617-641-9689
  • Fax: 617-566-8818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number13487
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number10451
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: