Provider Demographics
NPI:1861569436
Name:KUO, SU YONG (MD)
Entity type:Individual
Prefix:DR
First Name:SU YONG
Middle Name:
Last Name:KUO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 WARNER AVE
Mailing Address - Street 2:#154
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708
Mailing Address - Country:US
Mailing Address - Phone:714-545-9110
Mailing Address - Fax:714-545-1891
Practice Address - Street 1:11100 WARNER AVE
Practice Address - Street 2:#154
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708
Practice Address - Country:US
Practice Address - Phone:714-545-9110
Practice Address - Fax:714-545-1891
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32308207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A323080Medicaid
CA00A323080Medicaid
A32308Medicare ID - Type Unspecified