Healthcare Provider Details

I. General information

NPI: 1972566057
Provider Name (Legal Business Name): WAI CHUN YIP M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 01/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4895 WINDWARD PASSAGE DR SUITE 4
BOYNTON BEACH FL
33436-7741
US

IV. Provider business mailing address

4895 WINDWARD PASSAGE DR SUITE 4
BOYNTON BEACH FL
33436-7741
US

V. Phone/Fax

Practice location:
  • Phone: 561-733-3970
  • Fax: 561-733-3690
Mailing address:
  • Phone: 561-733-3970
  • Fax: 561-733-3690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME70491
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: