Healthcare Provider Details

I. General information

NPI: 1285625228
Provider Name (Legal Business Name): FELIX KUO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 PARK AVE SUITE 145
HUNTINGTON NY
11743-3976
US

IV. Provider business mailing address

775 PARK AVE SUITE 145
HUNTINGTON NY
11743-3976
US

V. Phone/Fax

Practice location:
  • Phone: 631-367-5395
  • Fax: 631-351-4562
Mailing address:
  • Phone: 631-367-5395
  • Fax: 631-351-4562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number220481
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number250872
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberA95073
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: