1902861073 NPI number — CHRISTINE V KU M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902861073 NPI number — CHRISTINE V KU M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KU
Provider First Name:
CHRISTINE
Provider Middle Name:
V
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VO
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902861073
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5757 WARREN PKWY
Provider Second Line Business Mailing Address:
# 200
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75034-4274
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-618-7100
Provider Business Mailing Address Fax Number:
214-618-7101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5757 WARREN PKWY
Provider Second Line Business Practice Location Address:
# 200
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75034-4274
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-618-7100
Provider Business Practice Location Address Fax Number:
214-618-7101
Provider Enumeration Date:
04/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  39348 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: L5944 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000375240 . This is a "ANTHEM - CMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000023025Q . This is a "HUMANA - CMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200871220 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1227035 . This is a "CHA - CMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: L5944 . This is a "STATE LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2666619000 . This is a "PASSPORT ADVTG - CMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50009103 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64112063 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200871220 . This is a "MDWISE - CMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 6183852 . This is a "CIGNA - CMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P00365857 . This is a "MCR - RR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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