Healthcare Provider Details

I. General information

NPI: 1225237498
Provider Name (Legal Business Name): JIMMY YIP O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5755 COTTLE RD BLDG 25
SAN JOSE CA
95123-3640
US

IV. Provider business mailing address

5755 COTTLE RD BLDG 25
SAN JOSE CA
95123-3640
US

V. Phone/Fax

Practice location:
  • Phone: 408-972-3413
  • Fax:
Mailing address:
  • Phone: 408-972-3413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13314
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: