Simon Wu MD LTD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SIMON WU MD LTD

Practice address

400 N Wall St Ste 303
Kankakee, IL 60901-2964

Phone

(815) 933-1664

Fax

(815) 935-5660

NPI assigned

Oct 13, 2005

Organization subpart

No

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

Authorized official

Name

Jennifer L Klinckman

Title

Office Manager

Phone

(815) 933-1664

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Simon K Wu, MD

  • Family Medicine Physician
  • Kankakee, IL
  • NPI 1407044241
  Medicare reassignment NPD

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

{
    "created_epoch": "1129161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733875200000",
    "number": "1831187715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 N WALL ST STE 303",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609012964",
            "telephone_number": "815-933-1664",
            "fax_number": "815-935-5660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N WALL ST STE 303",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609012964",
            "telephone_number": "815-933-1664",
            "fax_number": "815-935-5660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIMON WU MD LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-13",
        "last_updated": "2024-12-11",
        "certification_date": "2024-12-11",
        "status": "A",
        "authorized_official_last_name": "KLINCKMAN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "815-933-1664"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Rene Shelby, PHLEBOTOMIST
• Kortney Latrice Shoemaker
• Amy Lynn Shronts, MHS/CCC-SLP
• Firas Sibai, MD
• Anna Simms, L.AC.
• James John Simone, PSY.D.
• Heather Eileen Simpson
• Sasha Singh, DO
• Emily Skelly
• Skreen Pro Solutions LLC

• Family Medicine Physician in Kankakee, IL
• Providers in Kankakee, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.