Healthcare Provider Details

I. General information

NPI: 1841485588
Provider Name (Legal Business Name): YU JIE JACK KUO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1356 E WALNUT ST
SEGUIN TX
78155-5126
US

IV. Provider business mailing address

1356 E WALNUT ST
SEGUIN TX
78155-5126
US

V. Phone/Fax

Practice location:
  • Phone: 830-372-5588
  • Fax: 830-372-5400
Mailing address:
  • Phone: 830-372-5588
  • Fax: 830-372-5400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberJ9588
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: