Provider Demographics
NPI:1043701071
Name:IU, KIN WAH (RD, CDN, CNSC, RYT)
Entity type:Individual
Prefix:
First Name:KIN WAH
Middle Name:
Last Name:IU
Suffix:
Gender:F
Credentials:RD, CDN, CNSC, RYT
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:IU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, CDN, CNSC, RYT
Mailing Address - Street 1:220 5TH AVE FL 11
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-8017
Mailing Address - Country:US
Mailing Address - Phone:212-400-7126
Mailing Address - Fax:
Practice Address - Street 1:33 W 19TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-4333
Practice Address - Country:US
Practice Address - Phone:212-400-7126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86031412133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty