Provider Demographics
NPI:1881778157
Name:YU-JIE 'JACK' KUO M.D.,P.A.
Entity type:Organization
Organization Name:YU-JIE 'JACK' KUO M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:YU-JIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KUO
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:830-372-5588
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
Mailing Address - Country:US
Mailing Address - Phone:830-372-5588
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ95888173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00113VMedicare PIN