Healthcare Provider Details

I. General information

NPI: 1710048822
Provider Name (Legal Business Name): KUO FON HUANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 E CHEROKEE ST
SPRINGFIELD MO
65804-2203
US

IV. Provider business mailing address

14100 FIVAY RD STE 300
HUDSON FL
34667-7160
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-3960
  • Fax:
Mailing address:
  • Phone: 727-372-4417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME158508
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number111359
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: