Provider Demographics
NPI:1326128844
Name:WU, KEN DUONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEN
Middle Name:DUONG
Last Name:WU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17530 132ND AVE NE STE H
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-8500
Mailing Address - Country:US
Mailing Address - Phone:425-489-1166
Mailing Address - Fax:425-489-3066
Practice Address - Street 1:17530 132ND AVE NE STE H
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-8500
Practice Address - Country:US
Practice Address - Phone:425-489-1166
Practice Address - Fax:425-489-3066
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA88101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice