Provider Demographics
NPI:1275297640
Name:KWONG, WAN YU
Entity type:Individual
Prefix:
First Name:WAN YU
Middle Name:
Last Name:KWONG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 W EXCHANGE PKWY
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-7016
Mailing Address - Country:US
Mailing Address - Phone:972-908-2769
Mailing Address - Fax:
Practice Address - Street 1:925 W EXCHANGE PKWY
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-7016
Practice Address - Country:US
Practice Address - Phone:972-908-2769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-22
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06918133V00000X
TXDT06918133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered