Healthcare Provider Details

I. General information

NPI: 1063301422
Provider Name (Legal Business Name): EPHU YIP-NGO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 07/01/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 1ST AVE
SAN DIEGO CA
92103
US

IV. Provider business mailing address

11064 AVENIDA PLAYA VERACRUZ
SAN DIEGO CA
92124-4112
US

V. Phone/Fax

Practice location:
  • Phone: 415-290-8175
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number71639
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: