Healthcare Provider Details

I. General information

NPI: 1013357102
Provider Name (Legal Business Name): TIM KUO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 11/15/2020
Certification Date: 11/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 SAINT ROSE PKWY
HENDERSON NV
89052-3839
US

IV. Provider business mailing address

3001 SAINT ROSE PKWY
HENDERSON NV
89052-3839
US

V. Phone/Fax

Practice location:
  • Phone: 702-616-6102
  • Fax:
Mailing address:
  • Phone: 702-616-6102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO2201
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A17032
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101020513
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: