Provider Demographics
NPI:1811347024
Name:KU, SUSAN (DDS)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:KU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3580 LOUIS RD
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-4405
Mailing Address - Country:US
Mailing Address - Phone:650-283-0502
Mailing Address - Fax:
Practice Address - Street 1:3901 MAIN ST STE 211
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5435
Practice Address - Country:US
Practice Address - Phone:718-762-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-18
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059630122300000X
CA107282122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist