Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 20A12571 | CA |
NPI | 1003151085 |
---|---|
Provider Name | Dr. Anne Kuo |
First Address | Glendale, CA 91208-1211 |
Second Address | Glendale, CA 91208-1211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2012 |
Last Update Date | 05/02/2015 |