Provider Demographics
NPI:1285625228
Name:KUO, FELIX (MD)
Entity type:Individual
Prefix:DR
First Name:FELIX
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 1:775 PARK AVE
Mailing Address - Street 2:SUITE 145
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3976
Mailing Address - Country:US
Mailing Address - Phone:631-367-5395
Mailing Address - Fax:631-351-4562
Practice Address - Street 1:775 PARK AVE
Practice Address - Street 2:SUITE 145
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3976
Practice Address - Country:US
Practice Address - Phone:631-367-5395
Practice Address - Fax:631-351-4562
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220481207N00000X
NY250872207N00000X
CAA95073207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2101785Medicaid
1285625228OtherNPI
CA00A950730OtherINDIVIDUAL PTAN
MA2101785Medicaid