Healthcare Provider Details

I. General information

NPI: 1184739831
Provider Name (Legal Business Name): MORRIS CHUK MING YIP DDS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 SOUTH SECOND AVE
COVINA CA
91723-3518
US

IV. Provider business mailing address

677 SOUTH SECOND AVE
COVINA CA
91723-3518
US

V. Phone/Fax

Practice location:
  • Phone: 626-332-6284
  • Fax: 626-332-0167
Mailing address:
  • Phone: 626-332-6284
  • Fax: 626-332-0167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number033176
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: