=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114291358
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR MAY-CHANG KUO MDSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2012
-----------------------------------------------------
Last Update Date | 08/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 74 63RD ST
-----------------------------------------------------
City | WILLOWBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60527-2982
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-323-2300
-----------------------------------------------------
Fax | 630-323-3157
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 74 63RD ST
-----------------------------------------------------
City | WILLOWBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60527-2982
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-323-2300
-----------------------------------------------------
Fax | 630-323-3157
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MAY C KUO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 630-323-2300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 036047954
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------