Provider Demographics
NPI:1164631966
Name:KUO, JACK I (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:I
Last Name:KUO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11863 DARLINGTON AVE
Mailing Address - Street 2:UNIT G1
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-7223
Mailing Address - Country:US
Mailing Address - Phone:310-696-1288
Mailing Address - Fax:
Practice Address - Street 1:11863 DARLINGTON AVE
Practice Address - Street 2:UNIT G1
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-7223
Practice Address - Country:US
Practice Address - Phone:310-696-1288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA774212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry