MEDICARE: KA WA YIP M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	451659	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	451659	OTHER	NY	NEW YORK STATE EDUCATION DEPARTMENT

General Provider Information

NPI Number	:	1346673217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KA WA YIP M.S.

Provider Business Mailing Address
First Line	:	344 VAN SICKLEN ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-3802
Country	:	US
Telephone Number	:	347-633-7797
Fax Number	:

Provider Business Practice Location Address
First Line	:	344 VAN SICKLEN ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-3802
Country	:	US
Telephone Number	:	347-633-7797
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2013
Last Update Date	:	08/15/2013

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