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General NPI Number Information
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NPI Number | 1558535278
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Entity Type | Individual
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Provider Name | JOANNA KU D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/14/2008
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Last Update Date | 07/19/2023
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Provider Practice Location Address
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Address Line | 1 BELMONT AVE STE 316
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City | BALA CYNWYD
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State | PA
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Zip | 19004-1604
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Country | US
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Telephone | 215-477-8941
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Fax |
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Provider Business Mailing Address
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Address Line | 704 S 6TH ST APT 3
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City | PHILADELPHIA
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State | PA
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Zip | 19147-2150
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Country | US
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Telephone | 917-868-3736
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DS036777
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License Number State | PA
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