Healthcare Provider Details

I. General information

NPI: 1669810859
Provider Name (Legal Business Name): TONY W. KU, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
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 TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD424249
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD424249
License Number StatePA

VIII. Authorized Official

Name: TONY W KU
Title or Position: OWNER
Credential: MD
Phone: 610-857-7771