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General NPI Number Information
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NPI Number | 1194907386
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Entity Type | Organization
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Legal Business Name | KOHSIU KU DDS INC
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Dates
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Enumeration Date | 11/29/2007
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Last Update Date | 10/14/2013
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Provider Practice Location Address
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Address Line | 4045 S EASTERN AVE
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City | LAS VEGAS
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State | NV
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Zip | 89119
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Country | US
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Telephone | 702-892-9878
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Fax | 702-892-9073
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Provider Business Mailing Address
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Address Line | 4045 S EASTERN AVE
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City | LAS VEGAS
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State | NV
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Zip | 89119
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Country | US
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Telephone | 702-892-9878
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Fax | 702-892-9073
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. KOHSIU KU
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Credential | DDS
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Telephone | 702-892-9878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4996T
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4996T
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License Number State | NV
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