Provider Demographics
NPI:1801275235
Name:KU, TAE SUNG (DMD)
Entity type:Individual
Prefix:
First Name:TAE SUNG
Middle Name:
Last Name:KU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 M ST NW
Mailing Address - Street 2:SUITE 305
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-1445
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2311 M ST NW
Practice Address - Street 2:SUITE 305
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1445
Practice Address - Country:US
Practice Address - Phone:202-419-7587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-18
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1001537122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist