MEDICARE: DR. KENNETH Y WU D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist		IL

General Provider Information

NPI Number	:	1164411757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH Y WU D.D.S.

Provider Business Mailing Address
First Line	:	5624 W 79TH ST
Second Line	:	#5
City	:	BURBANK
State	:	IL
Zip	:	60459-1381
Country	:	US
Telephone Number	:	630-209-5351
Fax Number	:

Provider Business Practice Location Address
First Line	:	5624 W 79TH ST
Second Line	:	#5
City	:	BURBANK
State	:	IL
Zip	:	60459-1381
Country	:	US
Telephone Number	:	630-209-5351
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	07/08/2007

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