Provider Demographics
NPI:1083375695
Name:KU, SANDY (DMD)
Entity Type:Individual
Prefix:DR
First Name:SANDY
Middle Name:
Last Name:KU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19671 VERONA LN
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-2858
Mailing Address - Country:US
Mailing Address - Phone:714-329-4356
Mailing Address - Fax:
Practice Address - Street 1:19671 VERONA LN
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-2858
Practice Address - Country:US
Practice Address - Phone:714-329-4356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107176122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist