Healthcare Provider Details

I. General information

NPI: 1902097793
Provider Name (Legal Business Name): AMOS WING KEUNG YIP LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 10/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 8TH ST STE 200A
OAKLAND CA
94607-6527
US

IV. Provider business mailing address

310 8TH ST STE 200A
OAKLAND CA
94607-6527
US

V. Phone/Fax

Practice location:
  • Phone: 510-735-3900
  • Fax:
Mailing address:
  • Phone: 510-735-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number53394
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: