Healthcare Provider Details

I. General information

NPI: 1346283637
Provider Name (Legal Business Name): TONY WEN-WEI KU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 DARBY RD STE 1
PAOLI PA
19301-1480
US

IV. Provider business mailing address

53 DARBY RD STE 1
PAOLI PA
19301-1480
US

V. Phone/Fax

Practice location:
  • Phone: 610-857-7771
  • Fax: 610-857-7772
Mailing address:
  • Phone: 610-857-7771
  • Fax: 610-857-7772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD424249
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: