Healthcare Provider Details

I. General information

NPI: 1144463183
Provider Name (Legal Business Name): DR. VINCENT KUO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 11/03/2022
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12400 DALLAS PKWY
FRISCO TX
75033-4224
US

IV. Provider business mailing address

PO BOX 845347
DALLAS TX
75284-7208
US

V. Phone/Fax

Practice location:
  • Phone: 469-495-2540
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberN6905
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: