Healthcare Provider Details

I. General information

NPI: 1588898126
Provider Name (Legal Business Name): KUANG KUO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 MITCHELL AVE SUITE G50
BINGHAMTON NY
13903-1642
US

IV. Provider business mailing address

346 GRAND AVE
JOHNSON CITY NY
13790-2580
US

V. Phone/Fax

Practice location:
  • Phone: 607-771-2220
  • Fax: 607-771-2225
Mailing address:
  • Phone: 607-729-8156
  • Fax: 607-729-3982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number270413
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: