Provider Demographics
NPI:1346283637
Name:KU, TONY WEN-WEI (MD)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:WEN-WEI
Last Name:KU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 CLARK AVE
Mailing Address - Street 2:SUITE 17A
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1438
Mailing Address - Country:US
Mailing Address - Phone:610-857-7771
Mailing Address - Fax:610-857-7772
Practice Address - Street 1:625 CLARK AVE
Practice Address - Street 2:SUITE 17A
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1438
Practice Address - Country:US
Practice Address - Phone:610-857-7771
Practice Address - Fax:610-857-7772
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424249207LP2900X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0111571Medicaid
PA10119872400Medicaid
PA101198724 0004Medicaid
NJ0111571Medicaid
PA10119872400Medicaid