MEDICARE: MRS. GAIL KUDO RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	410396	CA

General Provider Information

NPI Number	:	1578430385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GAIL KUDO RN

Provider Business Mailing Address
First Line	:	1404 N LAUREL AVE
Second Line	:
City	:	UPLAND
State	:	CA
Zip	:	91786-2765
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1404 N LAUREL AVE
Second Line	:
City	:	UPLAND
State	:	CA
Zip	:	91786-2765
Country	:	US
Telephone Number	:	909-227-6159
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2025
Last Update Date	:	10/17/2025

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