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General NPI Number Information
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NPI Number | 1669810859
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Entity Type | Organization
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Legal Business Name | TONY W. KU, MD, LLC
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Dates
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Enumeration Date | 06/10/2013
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Last Update Date | 08/14/2013
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Provider Practice Location Address
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Address Line | 625 CLARK AVE SUITE 17A
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-1438
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Country | US
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Telephone | 610-857-7771
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Fax | 610-857-7772
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Provider Business Mailing Address
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Address Line | 625 CLARK AVE SUITE 17A
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-1438
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Country | US
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Telephone | 610-857-7771
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Fax | 610-857-7772
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Authorized Official
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Title or Position | OWNER
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Name | TONY W KU
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Credential | MD
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Telephone | 610-857-7771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | MD424249
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | MD424249
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License Number State | PA
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