Healthcare Provider Details

I. General information

NPI: 1992966469
Provider Name (Legal Business Name): JONATHANN C. KUO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 BROADWAY 2ND FLOOR
NEW YORK NY
10007-1831
US

IV. Provider business mailing address

281 BROADWAY 2ND FLOOR
NEW YORK NY
10007-1831
US

V. Phone/Fax

Practice location:
  • Phone: 646-596-7386
  • Fax: 646-360-2739
Mailing address:
  • Phone: 646-596-7386
  • Fax: 646-360-2739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number241732-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: