MEDICARE: DR. KIMCUC T. VO D.D.S.

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	122300000X	Dentist	18974	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	88D356	OTHER	TX	BCBS
2	B-18974-1	OTHER	TX	CHIP
3	983207	OTHER	TN	UNITED CONCORDIA

General Provider Information

NPI Number	:	1881868735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMCUC T. VO D.D.S.

Provider Business Mailing Address
First Line	:	12220 JONES RD.
Second Line	:	SUITE C
City	:	HOUSTON
State	:	TX
Zip	:	77070-5265
Country	:	US
Telephone Number	:	281-477-7200
Fax Number	:	281-477-7289

Provider Business Practice Location Address
First Line	:	12220 JONES RD.
Second Line	:	SUITE C
City	:	HOUSTON
State	:	TX
Zip	:	77070-5265
Country	:	US
Telephone Number	:	281-477-7200
Fax Number	:	281-477-7289

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

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	04/22/2008

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