Individual provider Active NPI

Linyue Kishi Peng, MS, RD, CDCES, LDN

  • Registered Dietitian
  • Broomall, PA
National Provider Identifier
1366908170
Registry record updated Sep 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
DN006398 Issued in PA
Practice address
1991 Sproul Rd
Broomall, PA 19008-3512
Phone
(484) 476-6230
NPI assigned
Feb 17, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X DN006398 PA Primary

Addresses

Primary practice location

1991 Sproul Rd
Broomall, PA 19008-3512

Mailing address

1991 Sproul Rd
Broomall, PA 19008-3512
Phone (484) 476-6230

Other practice location 1

625 Clark Ave Ste 17A
King Of Prussia, PA 19406-1438
Phone (610) 768-7168

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211210002117 PA Practitioner - Registered Dietitian Or Nutrition Professional 1052701786 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

625 Clark Ave
Suite 17a
King of Prussia, PA 19406-1438
Phone (484) 222-0224

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

Practice roles

OrganizationSpecialtyStatusNew patients
Advocare, LLC CurrentSince Sep 14, 2025 Accepting new patients
Advocare , LLC CurrentSince Sep 14, 2025 Accepting new patients
Advocare, LLC Past Accepting new patients

Locations

401 Route 73 N
Ste 320
Marlton, NJ 08053
Phone (609) 471-1033

515 Union Blvd
Ste 1
Totowa, NJ 07512
Phone (973) 595-0600

1100 Horizon Cir
Ste 101
Chalfont, PA 18914
Phone (215) 394-0400

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1550361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759190400000",
    "number": "1366908170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1991 SPROUL RD",
            "city": "BROOMALL",
            "state": "PA",
            "postal_code": "190083512",
            "telephone_number": "484-476-6230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1991 SPROUL RD",
            "city": "BROOMALL",
            "state": "PA",
            "postal_code": "190083512",
            "telephone_number": "484-476-6230"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "625 Clark Ave Ste 17A",
            "address_purpose": "LOCATION",
            "city": "King Of Prussia",
            "state": "PA",
            "postal_code": "194061438",
            "country_code": "US",
            "telephone_number": "610-768-7168",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PENG",
        "first_name": "LINYUE",
        "middle_name": "KISHI",
        "credential": "MS, RD, CDCES, LDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-17",
        "last_updated": "2025-09-30",
        "certification_date": "2025-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "PA",
            "license": "DN006398",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Broomall, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.