Provider Demographics
NPI:1043374028
Name:KY, PAUL
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:KY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6769 N FRESNO ST
Mailing Address - Street 2:STE. 206
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-3715
Mailing Address - Country:US
Mailing Address - Phone:559-435-1757
Mailing Address - Fax:559-435-1768
Practice Address - Street 1:6169 N THESTA ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5266
Practice Address - Country:US
Practice Address - Phone:559-435-1757
Practice Address - Fax:559-435-1768
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A-107432081P2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADM762ZMedicare UPIN