Healthcare Provider Details

I. General information

NPI: 1780189043
Provider Name (Legal Business Name): ELIM KUO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17183 INTERSTATE 45 S STE 110
THE WOODLANDS TX
77385
US

IV. Provider business mailing address

17183 INTERSTATE 45 SOUTH, SUITE 110
THE WOODLANDS TX
77385
US

V. Phone/Fax

Practice location:
  • Phone: 936-270-3480
  • Fax:
Mailing address:
  • Phone: 936-270-3480
  • Fax: 936-270-3479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberV1521
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: