Basic Information
| Provider Information | |||||||||
| NPI: | 1902861073 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KU | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | V | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | VO | ||||||||
| OtherFirstName: | CHRISTINE | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5757 WARREN PKWY | ||||||||
| Address2: | # 200 | ||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750344274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146187100 | ||||||||
| FaxNumber: | 2146187101 | ||||||||
| Practice Location | |||||||||
| Address1: | 5757 WARREN PKWY | ||||||||
| Address2: | # 200 | ||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750344274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146187100 | ||||||||
| FaxNumber: | 2146187101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 06/21/2011 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 39348 | KY | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | L5944 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 000000375240 | 01 | KY | ANTHEM - CMA | OTHER | 000023025Q | 01 | KY | HUMANA - CMA | OTHER | 200871220 | 05 | IN | MEDICAID | 1227035 | 01 | KY | CHA - CMA | OTHER | L5944 | 01 | TX | STATE LICENSE | OTHER | 2666619000 | 01 | KY | PASSPORT ADVTG - CMA | OTHER | 50009103 | 01 | KY | PASSPORT | OTHER | 64112063 | 05 | KY | MEDICAID | 200871220 | 01 | KY | MDWISE - CMA | OTHER | 6183852 | 01 | KY | CIGNA - CMA | OTHER | P00365857 | 01 | KY | MCR - RR | OTHER |