Healthcare Provider Details

I. General information

NPI: 1851780522
Provider Name (Legal Business Name): MRS. FANIS YIP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2015
Last Update Date: 01/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23521 PASEO DE VALENCIA STE B13
LAGUNA HILLS CA
92653-3145
US

IV. Provider business mailing address

23521 PASEO DE VALENCIA STE B13
LAGUNA HILLS CA
92653-3145
US

V. Phone/Fax

Practice location:
  • Phone: 949-228-1969
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 15730
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: