MEDICARE: DR. WAYNE T. 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	122300000X	Dentist	13766	TX

General Provider Information

NPI Number	:	1871656439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYNE T. KU DDS

Provider Business Mailing Address
First Line	:	6101 CHAPEL HILL BLVD STE 203
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-8448
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6101 CHAPEL HILL BLVD STE 203
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-8448
Country	:	US
Telephone Number	:	972-644-4881
Fax Number	:

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	07/08/2007

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