Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 138192 | CA |
N | 207NS0135X | Procedural Dermatology | A138195 | CA |
NPI | 1023438785 |
---|---|
Provider Name | Sandy Kuo |
First Address | Long Beach, CA 90808-1793 |
Second Address | Long Beach, CA 90808-1793 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2014 |
Last Update Date | 22/10/2020 |