Provider Demographics
NPI:1720217391
Name:KUO, SOPHIA (MD)
Entity Type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:
Last Name:KUO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 NE 65TH ST # 87777
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-6655
Mailing Address - Country:US
Mailing Address - Phone:206-741-4737
Mailing Address - Fax:833-645-0023
Practice Address - Street 1:3115 NE 47TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1822
Practice Address - Country:US
Practice Address - Phone:206-741-4737
Practice Address - Fax:833-645-0023
Is Sole Proprietor?:No
Enumeration Date:2009-07-05
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1637022084P0800X
MAUNKNOWN2084P0800X
ORMD1541632084P0800X, 2084P0804X
WAMD604715272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry