Healthcare Provider Details

I. General information

NPI: 1386055929
Provider Name (Legal Business Name): JOHN KUO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2014
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 GERARD AVE
BRONX NY
10452-8001
US

IV. Provider business mailing address

5800 ARLINGTON AVE APT 9S
BRONX NY
10471-1402
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-2911
  • Fax:
Mailing address:
  • Phone: 626-905-0382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number058276
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number058276
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: