MEDICARE: RAYMOND AU & AUGUSTINE AU DDS PC

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	122300000X	Dentist	DS 021021 L	PA

General Provider Information

NPI Number	:	1376754507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAYMOND AU & AUGUSTINE AU DDS PC

Provider Business Mailing Address
First Line	:	121 N 10TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-2402
Country	:	US
Telephone Number	:	215-923-1304
Fax Number	:	215-923-5730

Provider Business Practice Location Address
First Line	:	121 N 10TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-2402
Country	:	US
Telephone Number	:	215-923-1304
Fax Number	:	215-923-5730

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. AUGUSTINE CHI-KUEN AU
Credential	:	D.D.S.
Telephone Number	:	215-923-1304

Provider Enumeration Date	:	05/28/2007
Last Update Date	:	08/22/2020

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