Healthcare Provider Details

I. General information

NPI: 1487862066
Provider Name (Legal Business Name): JASON STEPHEN YIP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 S BEACH BLVD STE 211
ANAHEIM CA
92804-1869
US

IV. Provider business mailing address

408 S BEACH BLVD STE 211
ANAHEIM CA
92804-1869
US

V. Phone/Fax

Practice location:
  • Phone: 714-527-6000
  • Fax: 714-527-2371
Mailing address:
  • Phone: 714-527-6000
  • Fax: 714-527-2371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA120176
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: