Provider Demographics
NPI:1669810859
Name:TONY W. KU, MD, LLC
Entity type:Organization
Organization Name:TONY W. KU, MD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:W
Authorized Official - Last Name:KU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-857-7771
Mailing Address - Street 1:625 CLARK AVE
Mailing Address - Street 2:SUITE 17A
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1438
Mailing Address - Country:US
Mailing Address - Phone:610-857-7771
Mailing Address - Fax:610-857-7772
Practice Address - Street 1:625 CLARK AVE
Practice Address - Street 2:SUITE 17A
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1438
Practice Address - Country:US
Practice Address - Phone:610-857-7771
Practice Address - Fax:610-857-7772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-10
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424249207LP2900X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty