Healthcare Provider Details

I. General information

NPI: 1699805770
Provider Name (Legal Business Name): RICHARD A YAP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23517 MAIN ST #103
CARSON CA
90745-5251
US

IV. Provider business mailing address

24738 CARMEL DR
CARSON CA
90745-6448
US

V. Phone/Fax

Practice location:
  • Phone: 310-834-5388
  • Fax:
Mailing address:
  • Phone: 310-830-0307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number350987
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: