Healthcare Provider Details

I. General information

NPI: 1194591156
Provider Name (Legal Business Name): BETTY KUO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2023
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 45TH ST STE 101
BROOKLYN NY
11220-5286
US

IV. Provider business mailing address

151 E 3RD ST APT 2A
NEW YORK NY
10009-7423
US

V. Phone/Fax

Practice location:
  • Phone: 718-972-1233
  • Fax:
Mailing address:
  • Phone: 408-775-5593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number031014
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: