MEDICARE: DR. ANTHONY TYRONE KU DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	CA41635	CA

General Provider Information

NPI Number	:	1144434440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY TYRONE KU DDS

Provider Business Mailing Address
First Line	:	3 SUNRISE CT
Second Line	:
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-5584
Country	:	US
Telephone Number	:	415-999-4768
Fax Number	:

Provider Business Practice Location Address
First Line	:	931 EL CAMINO REAL
Second Line	:
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-3203
Country	:	US
Telephone Number	:	415-999-4768
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	07/08/2007

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