Provider Demographics
NPI:1700992310
Name:KUO, EDWARD LUNG-SHANG (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LUNG-SHANG
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:PO BOX 131165
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77219-1165
Mailing Address - Country:US
Mailing Address - Phone:713-851-5505
Mailing Address - Fax:713-861-5515
Practice Address - Street 1:4602 WASHINGTON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-5434
Practice Address - Country:US
Practice Address - Phone:713-861-5505
Practice Address - Fax:713-861-5515
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2008-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5594207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B5360Medicare PIN
TXG98264Medicare UPIN