Provider Demographics
NPI:1477526648
Name:MO, DOUGLAS TSUNG KUO (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:TSUNG KUO
Last Name:MO
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 1:111 E PUAINAKO ST
Mailing Address - Street 2:SUITE 104A
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-5288
Mailing Address - Country:US
Mailing Address - Phone:808-366-5568
Mailing Address - Fax:
Practice Address - Street 1:111 E PUAINAKO ST
Practice Address - Street 2:SUITE 104A
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5288
Practice Address - Country:US
Practice Address - Phone:808-959-3433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2013-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI23121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice