Kenneth R Wu, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD00045359 Issued in WA

Practice address

971 11TH Ave
Longview, WA 98632-2503

Phone

(360) 423-6140

Fax

(360) 423-1405

NPI assigned

Apr 21, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Child & Adolescent Clinic, PS

  • Pediatrics Physician
  • Longview, WA
  • NPI 1144275777
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1336105055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "971 11TH AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322503",
            "telephone_number": "360-423-6140",
            "fax_number": "360-423-1405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "971 11TH AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322503",
            "telephone_number": "360-423-6140",
            "fax_number": "360-423-1405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WU",
        "first_name": "KENNETH",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-21",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD00045359",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8440570",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Therese Ann Wortman, L.D.O.
• Tierna Wozniak, BS, AAC
• Tristan Shannon Wozniak, M.A. LMHC
• Danielle Summer Wright
• Christy Yanling Wu
• Robin Wulff
• Arvy Wuysang, MD
• Gare R Wyatt, MSW
• Jennifer Lynn Wyatt
• Jessica Wyatt, MS

• Pediatrics Physician in Longview, WA
• Providers in Longview, WA by specialty
• Pediatrics Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.