Healthcare Provider Details

I. General information

NPI: 1235435082
Provider Name (Legal Business Name): JONATHAN JAMES YIP PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8220 LONGLEAF DR
ELK GROVE CA
95758-1322
US

IV. Provider business mailing address

8220 LONGLEAF DR
ELK GROVE CA
95758-1322
US

V. Phone/Fax

Practice location:
  • Phone: 209-450-5614
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number25986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: