Provider Demographics
NPI:1154835981
Name:LAU, WING YAN (RDN)
Entity Type:Individual
Prefix:
First Name:WING YAN
Middle Name:
Last Name:LAU
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 W CHESTER PIKE APT H1
Mailing Address - Street 2:
Mailing Address - City:RIDLEY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19078-2015
Mailing Address - Country:US
Mailing Address - Phone:937-367-7763
Mailing Address - Fax:
Practice Address - Street 1:17 W CHESTER PIKE APT H1
Practice Address - Street 2:
Practice Address - City:RIDLEY PARK
Practice Address - State:PA
Practice Address - Zip Code:19078-2015
Practice Address - Country:US
Practice Address - Phone:937-367-7763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered