Provider Demographics
NPI:1558451914
Name:KUO, PAUL C (MD, DMD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:C
Last Name:KUO
Suffix:
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-3065
Mailing Address - Country:US
Mailing Address - Phone:617-641-9689
Mailing Address - Fax:617-566-8818
Practice Address - Street 1:209 HARVARD ST
Practice Address - Street 2:SUITE 405
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5005
Practice Address - Country:US
Practice Address - Phone:617-566-8800
Practice Address - Fax:617-566-8818
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA134871223S0112X
NH10451204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Not Answered204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC90842Medicare UPIN
MAKU X20063Medicare ID - Type Unspecified