Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | G57620 | CA |
NPI | 1144392952 |
---|---|
Provider Name | Berenice M Ku |
First Address | San Leandro, CA 94577-4201 |
Second Address | San Leandro, CA 94577-4201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 29/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G576200 | (05) | CA |
F15628 | (02) |