Provider Demographics
NPI:1922386291
Name:KU, JULIAN S (MD)
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:S
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 1:418 WARREN CRES
Mailing Address - Street 2:APT 5
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-2240
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:418 WARREN CRES
Practice Address - Street 2:APT 5
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-2240
Practice Address - Country:US
Practice Address - Phone:503-348-8183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101252303208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice