Provider Demographics
NPI:1932249273
Name:TRACY KU D.D.S.,INC
Entity Type:Organization
Organization Name:TRACY KU D.D.S.,INC
Other - Org Name:CALIFORNIA DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:KU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-288-2000
Mailing Address - Street 1:1448 S SAN GABRIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3656
Mailing Address - Country:US
Mailing Address - Phone:626-288-2000
Mailing Address - Fax:626-288-1402
Practice Address - Street 1:1448 S SAN GABRIEL BLVD
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3656
Practice Address - Country:US
Practice Address - Phone:626-288-2000
Practice Address - Fax:626-288-1402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA354151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty