Provider Demographics
NPI:1962538991
Name:KUO, LENA F (MD)
Entity type:Individual
Prefix:DR
First Name:LENA
Middle Name:F
Last Name:KUO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 N VANCOUVER AVE
Mailing Address - Street 2:SUITE 165
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1630
Mailing Address - Country:US
Mailing Address - Phone:503-413-2902
Mailing Address - Fax:503-413-1623
Practice Address - Street 1:2800 N VANCOUVER AVE
Practice Address - Street 2:SUITE 165
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1630
Practice Address - Country:US
Practice Address - Phone:503-413-2902
Practice Address - Fax:503-413-1623
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044498208000000X
ORMD27703171100000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ962036Medicaid
OR274603Medicaid
WA8493736Medicaid
AZ8HE326Medicare ID - Type UnspecifiedMEDICARE PART B - CHINLE
AZ8HE327Medicare ID - Type UnspecifiedMEDICARE PART B - PINON
OR145200Medicare PIN
AZ962036Medicaid
WA8493736Medicaid