Provider Demographics
NPI:1184972432
Name:KUO, KAITLYN (PSYD)
Entity type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:
Last Name:KUO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MRS
Other - First Name:CHAO CHIN
Other - Middle Name:
Other - Last Name:KUO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1968 S COAST HWY STE 1493
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-3681
Mailing Address - Country:US
Mailing Address - Phone:949-229-1314
Mailing Address - Fax:
Practice Address - Street 1:1968 S COAST HWY STE 1493
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-3681
Practice Address - Country:US
Practice Address - Phone:800-275-3243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29556103TC0700X, 103TC0700X
225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor