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General NPI Number Information
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NPI Number | 1093255093
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Entity Type | Organization
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Legal Business Name | TSJ KU PLLC
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Dates
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Enumeration Date | 02/24/2017
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Last Update Date | 02/24/2017
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Provider Practice Location Address
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Address Line | 2311 M ST NW SUITE 305
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City | WASHINGTON
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State | DC
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Zip | 20037-1445
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Country | US
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Telephone | 202-419-7587
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Fax |
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Provider Business Mailing Address
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Address Line | 2311 M ST NW SUITE 305
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City | WASHINGTON
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State | DC
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Zip | 20037-1445
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TAE SUNG JOHN KU
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Credential | D.M.D.
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Telephone | 213-248-0886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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