MEDICARE: DR. CHENG LONG KUO M.D.

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	208000000X	Pediatrics Physician	A031619	CA

General Provider Information

NPI Number	:	1689673840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHENG LONG KUO M.D.

Provider Business Mailing Address
First Line	:	1533 WEST LOMITA BLVD
Second Line	:
City	:	HARBOR CITY
State	:	CA
Zip	:	90710
Country	:	US
Telephone Number	:	310-539-4398
Fax Number	:	310-539-7921

Provider Business Practice Location Address
First Line	:	1533 WEST LOMITA BLVD
Second Line	:
City	:	HARBOR CITY
State	:	CA
Zip	:	90710
Country	:	US
Telephone Number	:	310-539-4398
Fax Number	:	310-539-7921

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	11/10/2011

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