Healthcare Provider Details

I. General information

NPI: 1316609696
Provider Name (Legal Business Name): AUSTEN BERNARD YIP DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 MOWRY AVE STE E
FREMONT CA
94536-4101
US

IV. Provider business mailing address

44946 COUGAR CIR
FREMONT CA
94539-6000
US

V. Phone/Fax

Practice location:
  • Phone: 510-745-7700
  • Fax:
Mailing address:
  • Phone: 510-585-5101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number300776
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: