Healthcare Provider Details

I. General information

NPI: 1336767029
Provider Name (Legal Business Name): JACQUELINE YIP DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 N CONGRESS AVE
BOYNTON BEACH FL
33426-3415
US

IV. Provider business mailing address

22714 ASPECT DR APT 301
BOCA RATON FL
33428-3659
US

V. Phone/Fax

Practice location:
  • Phone: 561-336-6560
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS042800
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0442000420
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN27688
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: