Basic Information
| Provider Information | |||||||||
| NPI: | 1932632338 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | KUO | ||||||||
| FirstName: | TIFFANY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11609 BIRCH SPRING CT | ||||||||
| Address2: | |||||||||
| City: | CUPERTINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950145138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6504501197 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6001 NORRIS CANYON RD | ||||||||
| Address2: | |||||||||
| City: | SAN RAMON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945835400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252759200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2017 | ||||||||
| LastUpdateDate: | 12/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A169912 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.