Healthcare Provider Details

I. General information

NPI: 1245523067
Provider Name (Legal Business Name): CONNIE KUO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST CAMPUS BOX 35651
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

1959 NE PACIFIC ST CAMPUS BOX 35651
SEATTLE WA
98195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-4022
  • Fax:
Mailing address:
  • Phone: 206-598-4022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberML60286775
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: