Healthcare Provider Details

I. General information

NPI: 1619929429
Provider Name (Legal Business Name): JAMES YUEN KUEN YIP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1552 COFFEE RD
MODESTO CA
95355-3107
US

IV. Provider business mailing address

1552 COFFEE RD
MODESTO CA
95355
US

V. Phone/Fax

Practice location:
  • Phone: 209-521-4372
  • Fax: 209-523-2005
Mailing address:
  • Phone: 209-521-4372
  • Fax: 209-523-2005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG41324
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: