Healthcare Provider Details

I. General information

NPI: 1275376139
Provider Name (Legal Business Name): LILLIAN YIP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 MARK WEST SPRINGS RD FL 3
SANTA ROSA CA
95403-1766
US

IV. Provider business mailing address

1511 STUBBINS WAY
SAN JOSE CA
95132-2341
US

V. Phone/Fax

Practice location:
  • Phone: 707-573-5416
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA67158
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: