=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346283637
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TONY WEN-WEI KU MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2006
-----------------------------------------------------
Last Update Date | 12/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 53 DARBY RD STE 1
-----------------------------------------------------
City | PAOLI
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19301-1480
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-857-7771
-----------------------------------------------------
Fax | 610-857-7772
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 53 DARBY RD STE 1
-----------------------------------------------------
City | PAOLI
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19301-1480
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-857-7771
-----------------------------------------------------
Fax | 610-857-7772
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | MD424249
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------