Provider Demographics
NPI:1548258502
Name:WANG, EMILY KUO (OD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:KUO
Last Name:WANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:EMILY
Other - Middle Name:L
Other - Last Name:KUO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:29 E. HUNTINGTON DR.
Mailing Address - Street 2:STE. B
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3210
Mailing Address - Country:US
Mailing Address - Phone:626-303-1888
Mailing Address - Fax:626-821-9696
Practice Address - Street 1:29 E. HUNTINGTON DR.
Practice Address - Street 2:STE. B
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3210
Practice Address - Country:US
Practice Address - Phone:626-303-1888
Practice Address - Fax:626-821-9696
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11164T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0111640Medicaid
CAWY196Medicare ID - Type UnspecifiedGROUP ID
CAWOP11164BMedicare ID - Type UnspecifiedMEMBER ID
CAU82725Medicare UPIN