Provider Demographics
NPI:1649594938
Name:KUO, HUNG-WEN
Entity Type:Individual
Prefix:
First Name:HUNG-WEN
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 1:3734 DELMAS TER
Mailing Address - Street 2:APT #19
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-5156
Mailing Address - Country:US
Mailing Address - Phone:406-370-1410
Mailing Address - Fax:
Practice Address - Street 1:3734 DELMAS TER
Practice Address - Street 2:APT #19
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-5156
Practice Address - Country:US
Practice Address - Phone:406-370-1410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD5785236390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program