Provider Demographics
NPI:1770733834
Name:ZHUK, IRENE (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:ZHUK
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:
Other - Last Name:BUENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LD
Mailing Address - Street 1:4018A HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-2224
Mailing Address - Country:US
Mailing Address - Phone:469-442-5727
Mailing Address - Fax:
Practice Address - Street 1:809 SINGLETON BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75212-4014
Practice Address - Country:US
Practice Address - Phone:214-651-8739
Practice Address - Fax:214-379-2281
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX949169133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX949169OtherREGISTERED DIETITIAN