Provider Demographics
NPI:1164967485
Name:BRIAN Y. KUO DDS CORP
Entity Type:Organization
Organization Name:BRIAN Y. KUO DDS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:YO-MING
Authorized Official - Last Name:KUO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-278-8669
Mailing Address - Street 1:1613 CHELSEA RD # 308
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2419
Mailing Address - Country:US
Mailing Address - Phone:626-278-8669
Mailing Address - Fax:
Practice Address - Street 1:118 LAS TUNAS DR
Practice Address - Street 2:SUITE D
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-8584
Practice Address - Country:US
Practice Address - Phone:626-278-8669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65039122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty