Healthcare Provider Details

I. General information

NPI: 1992872949
Provider Name (Legal Business Name): JAMIE CHING I KUO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 05/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 120TH AVE NE STE B210
BELLEVUE WA
98005-3038
US

IV. Provider business mailing address

6950 NE CAMPUS WAY
HILLSBORO OR
97124-5611
US

V. Phone/Fax

Practice location:
  • Phone: 425-453-1547
  • Fax:
Mailing address:
  • Phone: 503-952-2125
  • Fax: 503-526-4418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE00007073
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: