Provider Demographics
NPI:1235280587
Name:KU, ESTRELITA ONG (MD)
Entity Type:Individual
Prefix:DR
First Name:ESTRELITA
Middle Name:ONG
Last Name:KU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 SOUTHFIELD RD
Mailing Address - Street 2:APT. # 26
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-3700
Mailing Address - Country:US
Mailing Address - Phone:318-861-0061
Mailing Address - Fax:
Practice Address - Street 1:109 SOUTHFIELD RD
Practice Address - Street 2:APT. # 26
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-3700
Practice Address - Country:US
Practice Address - Phone:318-861-0061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD199977207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD55141Medicaid
MDH-330-L566Medicare ID - Type Unspecified
MD55141Medicaid