Healthcare Provider Details

I. General information

NPI: 1700992310
Provider Name (Legal Business Name): EDWARD LUNG-SHANG KUO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 01/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4602 WASHINGTON AVE SUITE B
HOUSTON TX
77007-5434
US

IV. Provider business mailing address

PO BOX 131165
HOUSTON TX
77219-1165
US

V. Phone/Fax

Practice location:
  • Phone: 713-861-5505
  • Fax: 713-861-5515
Mailing address:
  • Phone: 713-851-5505
  • Fax: 713-861-5515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberK5594
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: