Healthcare Provider Details

I. General information

NPI: 1174115521
Provider Name (Legal Business Name): JENNIFER JINYOUNG KUO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7372 LIBERTY ONE DR
LIBERTY TOWNSHIP OH
45044-8872
US

IV. Provider business mailing address

7372 LIBERTY ONE DR
LIBERTY TOWNSHIP OH
45044-8872
US

V. Phone/Fax

Practice location:
  • Phone: 513-751-6667
  • Fax: 513-682-4186
Mailing address:
  • Phone: 513-751-6667
  • Fax: 513-872-4553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.006712RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: