Healthcare Provider Details

I. General information

NPI: 1770503955
Provider Name (Legal Business Name): IAN YIP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6325 TOPANGA CYN BLVD SUITE 315
WOODLAND HILLS CA
91367-2033
US

IV. Provider business mailing address

6325 TOPANGA CYN BLVD SUITE 315
WOODLAND HILLS CA
91367-2033
US

V. Phone/Fax

Practice location:
  • Phone: 818-615-2888
  • Fax:
Mailing address:
  • Phone: 818-615-2888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberG73119
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: