NPIMap

Organization Active NPI

Kerry Wu DMD PC

  • General Practice Dentistry
  • Waltham, MA
National Provider Identifier
1710009477
Registry record updated Aug 22, 2020
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Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
19491 Issued in MA
Legal business name
KERRY WU DMD PC
Practice address
30 Grant St
Waltham, MA 02453
Phone
(781) 894-1634
Fax
(781) 899-3073
NPI assigned
Apr 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Kerry Wu, DMD
Title
President Dentist
Phone
(781) 894-1634

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 19491 MA Primary

Addresses

Primary practice location

30 Grant St
Waltham, MA 02453

Mailing address

30 Grant St
Waltham, MA 02453
Phone (781) 894-1634

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710009477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 GRANT ST",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "02453",
            "telephone_number": "781-894-1634",
            "fax_number": "781-899-3073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 GRANT ST",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "02453",
            "telephone_number": "781-894-1634",
            "fax_number": "781-899-3073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KERRY WU DMD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WU",
        "authorized_official_first_name": "KERRY",
        "authorized_official_title_or_position": "PRESIDENT DENTIST",
        "authorized_official_telephone_number": "781-894-1634",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "19491",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waltham, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.