Healthcare Provider Details

I. General information

NPI: 1295915908
Provider Name (Legal Business Name): COKA K YIP NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIU WAN YIP NP

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 07/27/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8723 ALDEN DR. SUITE 215
LOS ANGELES CA
90048
US

IV. Provider business mailing address

4140 W 190TH ST
TORRANCE CA
90504-5513
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-1246
  • Fax: 310-423-8356
Mailing address:
  • Phone: 310-423-1246
  • Fax: 310-423-8356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704234938
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20570
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: