Provider Demographics
NPI:1710333414
Name:WU, DOMINIC (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:
Last Name:WU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 871353
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64187-1353
Mailing Address - Country:US
Mailing Address - Phone:816-584-8100
Mailing Address - Fax:816-584-8106
Practice Address - Street 1:9301 W 74TH ST STE 230
Practice Address - Street 2:
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-2217
Practice Address - Country:US
Practice Address - Phone:816-584-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-45508207N00000X
MO2022012327207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology