Healthcare Provider Details

I. General information

NPI: 1861019614
Provider Name (Legal Business Name): BRYAN KUO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2020
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PARK AVE
FALLS CHURCH VA
22046-4300
US

IV. Provider business mailing address

200 PARK AVE
FALLS CHURCH VA
22046-4300
US

V. Phone/Fax

Practice location:
  • Phone: 571-634-3636
  • Fax:
Mailing address:
  • Phone: 571-634-3636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number3013596
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT220567
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number0101288737
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: