Healthcare Provider Details

I. General information

NPI: 1710187638
Provider Name (Legal Business Name): SAMUEL YIP M.D,PH.D,FRCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR
SAN DIEGO CA
92103-9001
US

IV. Provider business mailing address

3535 LEBON DR #3211
SAN DIEGO CA
92122-4593
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-6266
  • Fax: 619-543-5793
Mailing address:
  • Phone: 619-502-1451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberA100706
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: