Provider Demographics
NPI:1568490167
Name:KU, MIN H (DDS)
Entity Type:Individual
Prefix:
First Name:MIN
Middle Name:H
Last Name:KU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27349 JEFFERSON AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5634
Mailing Address - Country:US
Mailing Address - Phone:951-296-6330
Mailing Address - Fax:951-296-6337
Practice Address - Street 1:27349 JEFFERSON AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5634
Practice Address - Country:US
Practice Address - Phone:951-296-6330
Practice Address - Fax:951-296-6337
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA551191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice