Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | MD445301 | PA |
N | 208000000X | Pediatrician | MD445301 | PA |
Y | 2080P0204X | Pediatric Emergency Doctor | MD445301 | PA |
NPI | 1114157435 |
---|---|
Provider Name | Brandon C. Ku |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2009 |
Last Update Date | 16/04/2013 |