Provider Demographics
NPI:1487622445
Name:KUO, PHILBERT (DPM)
Entity type:Individual
Prefix:DR
First Name:PHILBERT
Middle Name:
Last Name:KUO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 CHURCHLAND BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5262
Mailing Address - Country:US
Mailing Address - Phone:757-483-4126
Mailing Address - Fax:757-483-6443
Practice Address - Street 1:3212 CHURCHLAND BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5262
Practice Address - Country:US
Practice Address - Phone:757-483-4126
Practice Address - Fax:757-483-6443
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103001032213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
6225080001Medicare NSC