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NPI Code Detail

MEDICARE: LISA KU D.D.S.

MEDICARE: LISA KU D.D.S.
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
1122300000XDentistCA51866CA
2122300000XDentistDE 60258242WA

General Provider Information

NPI Number : 1346306511
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA KU D.D.S.
Provider Business Mailing Address
First Line : 1019 PACIFIC AVE
Second Line : STE. 300
City : TACOMA
State : WA
Zip : 98402-4443
Country : US
Telephone Number : 253-597-4550
Fax Number : 253-597-4556
Provider Business Practice Location Address
First Line : 1708 E 44TH ST
Second Line :
City : TACOMA
State : WA
Zip : 98404-4611
Country : US
Telephone Number : 253-572-7002
Fax Number : 253-593-2854
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2006
Last Update Date : 11/12/2015

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Directions to “ LISA KU D.D.S.” Practice Location

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