Healthcare Provider Details

I. General information

NPI: 1073994331
Provider Name (Legal Business Name): STEPHEN YIP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 OAKLAND RD STE A115
SAN JOSE CA
95131-2461
US

IV. Provider business mailing address

1449 PARK AVE STE 1
SAN JOSE CA
95126-2529
US

V. Phone/Fax

Practice location:
  • Phone: 408-982-5290
  • Fax:
Mailing address:
  • Phone: 510-828-9922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number16689
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: