Healthcare Provider Details

I. General information

NPI: 1619991114
Provider Name (Legal Business Name): NAN-HSIEN KUO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5645 MAIN ST SUITE 637
FLUSHING NY
11355-5045
US

IV. Provider business mailing address

PO BOX 27842
NEW YORK NY
10087-7842
US

V. Phone/Fax

Practice location:
  • Phone: 718-670-1424
  • Fax: 516-437-4167
Mailing address:
  • Phone: 718-670-1651
  • Fax: 516-437-4167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number240560
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number26NJ01369300
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number240560
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number25MA10966500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: