Healthcare Provider Details

I. General information

NPI: 1568201663
Provider Name (Legal Business Name): TONY YIP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1357 KAPIOLANI BLVD STE 800
HONOLULU HI
96814-4536
US

IV. Provider business mailing address

2354 APOEPOE ST
PEARL CITY HI
96782-1035
US

V. Phone/Fax

Practice location:
  • Phone: 808-523-9043
  • Fax:
Mailing address:
  • Phone: 808-218-9748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAT-13953
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: