Provider Demographics
NPI:1851520738
Name:KUO, EDDIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:
Last Name:KUO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3730
Mailing Address - Country:US
Mailing Address - Phone:559-791-7000
Mailing Address - Fax:559-782-1418
Practice Address - Street 1:501 NORTH BRIDGE STREET
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5014
Practice Address - Country:US
Practice Address - Phone:559-734-1939
Practice Address - Fax:559-734-4384
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA987654321122300000X
CA58718122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist