Provider Demographics
NPI:1609241314
Name:KUO, SHYH-SHIAW
Entity Type:Individual
Prefix:
First Name:SHYH-SHIAW
Middle Name:
Last Name:KUO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21710 STEVENS CREEK BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-1179
Mailing Address - Country:US
Mailing Address - Phone:408-458-5256
Mailing Address - Fax:
Practice Address - Street 1:21710 STEVENS CREEK BLVD STE 105
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-1179
Practice Address - Country:US
Practice Address - Phone:408-458-5256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-07
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100408106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA90096OtherCA BBS