Provider Demographics
NPI:1265858138
Name:KUO, SAMUEL EN-TAO (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:EN-TAO
Last Name:KUO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 COMMERCIAL WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1819
Mailing Address - Country:US
Mailing Address - Phone:831-464-5409
Mailing Address - Fax:
Practice Address - Street 1:1830 COMMERCIAL WAY
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1819
Practice Address - Country:US
Practice Address - Phone:831-464-5409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63064122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist