Provider Demographics
NPI:1902861073
Name:KU, CHRISTINE V (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:V
Last Name:KU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:VO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5757 WARREN PKWY
Mailing Address - Street 2:# 200
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4274
Mailing Address - Country:US
Mailing Address - Phone:214-618-7100
Mailing Address - Fax:214-618-7101
Practice Address - Street 1:5757 WARREN PKWY
Practice Address - Street 2:# 200
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4274
Practice Address - Country:US
Practice Address - Phone:214-618-7100
Practice Address - Fax:214-618-7101
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39348207V00000X
TXL5944207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000375240OtherANTHEM - CMA
KY000023025QOtherHUMANA - CMA
IN200871220Medicaid
KY1227035OtherCHA - CMA
TXL5944OtherSTATE LICENSE
KY2666619000OtherPASSPORT ADVTG - CMA
KY50009103OtherPASSPORT
KY64112063Medicaid
KY200871220OtherMDWISE - CMA
KY6183852OtherCIGNA - CMA
KYP00365857OtherMCR - RR
KYP00365857OtherMCR - RR
KY1361953Medicare PIN