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General NPI Number Information
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NPI Number | 1982090692
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Entity Type | Individual
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Provider Name | MICKEY JUSTIN MYLES KUO M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/09/2015
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Last Update Date | 08/05/2019
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Provider Practice Location Address
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Address Line | BG 10 RM 13N268 10 CENTER DR
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City | BETHESDA
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State | MD
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Zip | 20814
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Country | US
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Telephone | 301-594-7487
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Fax |
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Provider Business Mailing Address
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Address Line | BG 10 RM 13N268 10 CENTER DR
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City | BETHESDA
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State | MD
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Zip | 20814
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Country | US
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Telephone | 301-594-7487
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 125067676
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207SG0201X
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Taxonomy Name | Clinical Genetics (M.D.) Physician
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License Number | D0087738
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License Number State | MD
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