Individual
KAN Y WU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
907 WEST LINCOLN AVE, CHARLESTON, IL 61920-2413
(217) 345-2500
(217) 345-8366
Mailing address
PO BOX 770, 907 WEST LINCOLN AVE, CHARLESTON, IL 61920-2413
(217) 345-2500
(217) 345-8366
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
18855
NE
2085R0202X
Diagnostic Radiology Physician
Primary
036113712
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01098
BCBS OF NE
NE
05
—
036113712
—
IL
Enumeration date
09/30/2005
Last updated
04/25/2008
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