Provider Demographics
NPI:1225023658
Name:KUO, BRADEN (MD)
Entity type:Individual
Prefix:
First Name:BRADEN
Middle Name:
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 1:543 W 122ND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-5175
Mailing Address - Country:US
Mailing Address - Phone:617-543-1987
Mailing Address - Fax:
Practice Address - Street 1:543 W 122ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-5175
Practice Address - Country:US
Practice Address - Phone:617-543-1987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339940207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3195457Medicaid
MAA28563Medicare ID - Type Unspecified
MA3195457Medicaid