Provider Demographics
NPI:1841485588
Name:KUO, YU JIE JACK (MD)
Entity type:Individual
Prefix:
First Name:YU JIE
Middle Name:JACK
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 1:1356 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5126
Mailing Address - Country:US
Mailing Address - Phone:830-372-5588
Mailing Address - Fax:830-372-5400
Practice Address - Street 1:1356 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5126
Practice Address - Country:US
Practice Address - Phone:830-372-5588
Practice Address - Fax:830-372-5400
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9588207R00000X
TXJ95888207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G39292Medicare UPIN