Healthcare Provider Details

I. General information

NPI: 1568490894
Provider Name (Legal Business Name): JOHN S. KUO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 10/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 NESHAMINY INTERPLEX SUITE 209
TREVOSE PA
19053-6940
US

IV. Provider business mailing address

4 NESHAMINY INTERPLEX SUITE 209
TREVOSE PA
19053-6940
US

V. Phone/Fax

Practice location:
  • Phone: 215-244-3070
  • Fax: 215-638-9041
Mailing address:
  • Phone: 215-244-3070
  • Fax: 215-638-9041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMA075409
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA07540900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: