Healthcare Provider Details

I. General information

NPI: 1720228778
Provider Name (Legal Business Name): JARRET KUO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2009
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17310 WRIGHT ST STE 103
OMAHA NE
68130-2405
US

IV. Provider business mailing address

17310 WRIGHT ST STE 103
OMAHA NE
68130-2405
US

V. Phone/Fax

Practice location:
  • Phone: 833-228-6889
  • Fax: 877-853-0376
Mailing address:
  • Phone: 833-228-6889
  • Fax: 877-853-0376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME120107
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMC-180
License Number StateGU
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number60111
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberC170637
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number16520
License Number StateND
# 6
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number12822C
License Number StateWY
# 7
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME120107
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: