Healthcare Provider Details

I. General information

NPI: 1356365191
Provider Name (Legal Business Name): GREGORY DAVID KUO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15446 BEL RED RD SUITE 110
REDMOND WA
98052-5501
US

IV. Provider business mailing address

15446 BEL RED RD SUITE 110
REDMOND WA
98052-5501
US

V. Phone/Fax

Practice location:
  • Phone: 425-883-3656
  • Fax: 425-968-0029
Mailing address:
  • Phone: 425-883-3656
  • Fax: 425-968-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7672
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: