Healthcare Provider Details

I. General information

NPI: 1306258520
Provider Name (Legal Business Name): JEFFREY YIP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 05/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 KAPIOLANI BLVD STE 623
HONOLULU HI
96814-3802
US

IV. Provider business mailing address

1600 KAPIOLANI BLVD STE 623
HONOLULU HI
96814-3802
US

V. Phone/Fax

Practice location:
  • Phone: 808-225-8886
  • Fax:
Mailing address:
  • Phone: 808-225-8886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: