Provider Demographics
NPI:1518321611
Name:KUO, CARLA (LAC)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:KUO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 ILIMA PL
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-1728
Mailing Address - Country:US
Mailing Address - Phone:808-218-9234
Mailing Address - Fax:
Practice Address - Street 1:13 ILIMA PL
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-1728
Practice Address - Country:US
Practice Address - Phone:808-218-9234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI800171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist