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General NPI Number Information
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NPI Number | 1669800199
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Entity Type | Organization
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Legal Business Name | ELISA L KUO DDS, INC
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Dates
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Enumeration Date | 10/18/2013
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Last Update Date | 11/27/2013
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Provider Practice Location Address
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Address Line | 373 9TH ST STE 401
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City | OAKLAND
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State | CA
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Zip | 94607-6516
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Country | US
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Telephone | 510-834-4640
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Fax |
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Provider Business Mailing Address
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Address Line | 373 9TH ST STE 401
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City | OAKLAND
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State | CA
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Zip | 94607-6516
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Country | US
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Telephone | 510-834-4640
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN
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Name | DR. ELISA LING KUO
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Credential | D.D.S.
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Telephone | 510-834-4640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 50153
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License Number State | CA
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