Healthcare Provider Details

I. General information

NPI: 1972526705
Provider Name (Legal Business Name): RANDOLPH YIP D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 GEARY BLVD
SAN FRANCISCO CA
94118-2911
US

IV. Provider business mailing address

4800 GEARY BLVD
SAN FRANCISCO CA
94118-2911
US

V. Phone/Fax

Practice location:
  • Phone: 415-221-4800
  • Fax:
Mailing address:
  • Phone: 415-221-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number32785
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: