Provider Demographics
NPI:1568605632
Name:PHILBERT H. KUO, D.P.M.
Entity Type:Organization
Organization Name:PHILBERT H. KUO, D.P.M.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KUO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:757-483-4126
Mailing Address - Street 1:3212 CHURCHLAND BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5262
Mailing Address - Country:US
Mailing Address - Phone:757-483-4126
Mailing Address - Fax:757-483-6443
Practice Address - Street 1:3212 CHURCHLAND BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5262
Practice Address - Country:US
Practice Address - Phone:757-483-4126
Practice Address - Fax:757-483-6443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-19
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103001032213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009303651Medicaid
VA480000629Medicare PIN
VAU72181Medicare UPIN
VA009303651Medicaid