Healthcare Provider Details

I. General information

NPI: 1306013339
Provider Name (Legal Business Name): VICTORIA KUOHUNG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 HANCOCK ST SUITE 505S
QUINCY MA
02169-4339
US

IV. Provider business mailing address

1250 HANCOCK ST SUITE 505S
QUINCY MA
02169-4339
US

V. Phone/Fax

Practice location:
  • Phone: 781-253-7165
  • Fax: 781-253-7166
Mailing address:
  • Phone: 781-253-7165
  • Fax: 781-253-7166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number247440
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: