Provider Demographics
NPI:1730296963
Name:FU, SELENA Y (MD)
Entity Type:Individual
Prefix:DR
First Name:SELENA
Middle Name:Y
Last Name:FU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3147 W 145TH TER
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66224-3755
Mailing Address - Country:US
Mailing Address - Phone:917-623-5442
Mailing Address - Fax:
Practice Address - Street 1:10620 W 87TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66214-6621
Practice Address - Country:US
Practice Address - Phone:913-375-7258
Practice Address - Fax:816-208-0602
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.092189207W00000X
MI4301091335207W00000X
TXM7977207W00000X
CAA109292207W00000X
MO2015044685207W00000X, 207WX0200X
KS04-37971207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology