Healthcare Provider Details

I. General information

NPI: 1487877288
Provider Name (Legal Business Name): SARAH IRENE KUO D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 09/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2029 SUFFOLK RD
FINKSBURG MD
21048-1630
US

IV. Provider business mailing address

1211 S CONKLING ST APT #356
BALTIMORE MD
21224-5341
US

V. Phone/Fax

Practice location:
  • Phone: 410-861-3001
  • Fax:
Mailing address:
  • Phone: 310-991-2152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number55128
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number15857
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: