Healthcare Provider Details

I. General information

NPI: 1770733834
Provider Name (Legal Business Name): IRENE ZHUK MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: IRENE BUENO MS, RD, LD

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 SINGLETON BLVD
DALLAS TX
75212-4014
US

IV. Provider business mailing address

4018A HAWTHORNE AVE
DALLAS TX
75219-2224
US

V. Phone/Fax

Practice location:
  • Phone: 214-651-8739
  • Fax: 214-379-2281
Mailing address:
  • Phone: 469-442-5727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number949169
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: