Healthcare Provider Details

I. General information

NPI: 1366589251
Provider Name (Legal Business Name): MING-LI KUO DDS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2317 SW 320TH ST
FEDERAL WAY WA
98023-2567
US

IV. Provider business mailing address

2317 SW 320TH ST
FEDERAL WAY WA
98023-2567
US

V. Phone/Fax

Practice location:
  • Phone: 253-927-6411
  • Fax: 253-661-1564
Mailing address:
  • Phone: 253-927-6411
  • Fax: 253-661-1564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number9234
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: