Healthcare Provider Details

I. General information

NPI: 1881936276
Provider Name (Legal Business Name): GARY YIP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2013
Last Update Date: 12/16/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 OLD REDWOOD HWY
SANTA ROSA CA
95403-1719
US

IV. Provider business mailing address

3925 OLD REDWOOD HWY
SANTA ROSA CA
95403-1719
US

V. Phone/Fax

Practice location:
  • Phone: 707-566-7073
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA132708
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: