Provider Demographics
NPI:1508800756
Name:KU, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
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 1:604 E HUNTINGTON DR STE A
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-6351
Mailing Address - Country:US
Mailing Address - Phone:626-930-8700
Mailing Address - Fax:626-507-3136
Practice Address - Street 1:604 E HUNTINGTON DR STE A
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-6351
Practice Address - Country:US
Practice Address - Phone:626-930-8700
Practice Address - Fax:626-507-3136
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79482207R00000X, 207RA0000X, 2080A0000X
FLME147702207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A794820Medicaid
CAWA79482AMedicare ID - Type UnspecifiedMEDICARE PPIN
CA00A794820Medicaid