Healthcare Provider Details

I. General information

NPI: 1568675783
Provider Name (Legal Business Name): PENELOPE S.YIP D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 TELEGRAPH AVE
BERKELEY CA
94705-1118
US

IV. Provider business mailing address

2821 TELEGRAPH AVE
BERKELEY CA
94705-1118
US

V. Phone/Fax

Practice location:
  • Phone: 510-841-7424
  • Fax: 510-841-5066
Mailing address:
  • Phone: 510-841-7424
  • Fax: 510-841-5066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number42103
License Number StateCA

VIII. Authorized Official

Name: DR. PENELOPE S YIP
Title or Position: OWNER
Credential: D.D.S.
Phone: 510-841-7424