=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992966469
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JONATHANN C. KUO M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2008
-----------------------------------------------------
Last Update Date | 04/16/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 281 BROADWAY 2ND FLOOR
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10007-1831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-596-7386
-----------------------------------------------------
Fax | 646-360-2739
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 281 BROADWAY 2ND FLOOR
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10007-1831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-596-7386
-----------------------------------------------------
Fax | 646-360-2739
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | 241732-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------