Provider Demographics
NPI:1447326046
Name:KUO, TIMOTHY ING-HO (DDS)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ING-HO
Last Name:KUO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11745 23RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-5247
Mailing Address - Country:US
Mailing Address - Phone:206-459-4139
Mailing Address - Fax:
Practice Address - Street 1:12359 LAKE CITY WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-5401
Practice Address - Country:US
Practice Address - Phone:206-477-8072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000086481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5036231Medicaid
BK6641650OtherDEA