Healthcare Provider Details

I. General information

NPI: 1528507613
Provider Name (Legal Business Name): CLAIRE KUO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2017
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 N 185TH ST
SHORELINE WA
98133-3901
US

IV. Provider business mailing address

9622 S 177TH ST
RENTON WA
98055-5722
US

V. Phone/Fax

Practice location:
  • Phone: 206-542-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number60703133
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: