Healthcare Provider Details

I. General information

NPI: 1376846808
Provider Name (Legal Business Name): LAWRENCE KUO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2010
Last Update Date: 12/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1053 RED OAKS LOOP NE
ALBUQUERQUE NM
87122-1346
US

IV. Provider business mailing address

1053 RED OAKS LOOP NE
ALBUQUERQUE NM
87122-1346
US

V. Phone/Fax

Practice location:
  • Phone: 505-280-8948
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number91-235
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: