Healthcare Provider Details

I. General information

NPI: 1720217391
Provider Name (Legal Business Name): SOPHIA KUO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2009
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 NE 47TH AVE
PORTLAND OR
97213-1822
US

IV. Provider business mailing address

1037 NE 65TH ST # 87777
SEATTLE WA
98115-6655
US

V. Phone/Fax

Practice location:
  • Phone: 206-741-4737
  • Fax: 833-645-0023
Mailing address:
  • Phone: 206-741-4737
  • Fax: 833-645-0023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD163702
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberUNKNOWN
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD154163
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD154163
License Number StateOR
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD60471527
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: