Provider Demographics
NPI:1376952994
Name:KU, GEORGE (ACU)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:KU
Suffix:
Gender:M
Credentials:ACU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 S. DIAMOND BAR BLVD. UNIT 208
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3513
Mailing Address - Country:US
Mailing Address - Phone:909-833-1138
Mailing Address - Fax:
Practice Address - Street 1:2705 S DIAMOND BAR BLVD STE 208
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3554
Practice Address - Country:US
Practice Address - Phone:909-833-1138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 11602171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist