Provider Demographics
NPI:1164411757
Name:WU, KENNETH Y (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:Y
Last Name:WU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5624 W 79TH ST
Mailing Address - Street 2:#5
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-1381
Mailing Address - Country:US
Mailing Address - Phone:630-209-5351
Mailing Address - Fax:
Practice Address - Street 1:5624 W 79TH ST
Practice Address - Street 2:#5
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1381
Practice Address - Country:US
Practice Address - Phone:630-209-5351
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist