Healthcare Provider Details

I. General information

NPI: 1730296963
Provider Name (Legal Business Name): SELENA Y FU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13300 METCALF AVE
OVERLAND PARK KS
66213-2804
US

IV. Provider business mailing address

3147 W 145TH TER
LEAWOOD KS
66224-3755
US

V. Phone/Fax

Practice location:
  • Phone: 913-387-1104
  • Fax: 816-208-0602
Mailing address:
  • Phone: 917-623-5442
  • Fax: 816-208-0602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35.092189
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA109292
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4301091335
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberM7977
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2015044685
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number2015044685
License Number StateMO
# 7
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number04-37971
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: