Provider Demographics
NPI:1710986161
Name:KU, WEN-TSANG (MD)
Entity Type:Individual
Prefix:DR
First Name:WEN-TSANG
Middle Name:
Last Name:KU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:KU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2360 MCKEE RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1618
Mailing Address - Country:US
Mailing Address - Phone:408-729-7128
Mailing Address - Fax:408-729-4125
Practice Address - Street 1:2360 MCKEE RD
Practice Address - Street 2:SUITE 10
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1618
Practice Address - Country:US
Practice Address - Phone:408-729-7128
Practice Address - Fax:408-729-4125
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43854207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A438540Medicaid
CAA29745Medicare UPIN
CA00A438540Medicaid