Healthcare Provider Details

I. General information

NPI: 1750568770
Provider Name (Legal Business Name): CATHERINE LEI KUO D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 S 40TH ST
PHILADELPHIA PA
19104-6030
US

IV. Provider business mailing address

9 SPRINGVILLE WAY
MOUNT LAUREL NJ
08054-5729
US

V. Phone/Fax

Practice location:
  • Phone: 215-898-5344
  • Fax:
Mailing address:
  • Phone: 856-581-9178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI02328100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS036995
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: