Provider Demographics
NPI:1922033620
Name:KUO, RAYMOND H (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:H
Last Name:KUO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 COTNER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3303
Mailing Address - Country:US
Mailing Address - Phone:310-445-2951
Mailing Address - Fax:310-479-1459
Practice Address - Street 1:230 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3851
Practice Address - Country:US
Practice Address - Phone:714-978-2937
Practice Address - Fax:714-978-2518
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA789202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A789200OtherBLUE SHIELD
CA1922033620Medicaid
CA00A789200Medicaid
CAAS118YMedicare PIN
CA00A789201Medicare PIN
CAAO603QMedicare PIN
CA00A789200OtherBLUE SHIELD
CAAO603SMedicare PIN
CA1922033620Medicaid
CAAO603RMedicare PIN
CA00A789200Medicare PIN
CAWA78920BMedicare PIN
CAI 74487Medicare UPIN
CA00A789200Medicaid