Healthcare Provider Details

I. General information

NPI: 1669550133
Provider Name (Legal Business Name): LISA L YIP DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 KAMOKILA BLVD SUITE 111 JCB
KAPOLEI HI
96707-2014
US

IV. Provider business mailing address

1001 KAMOKILA BLVD SUITE 111 JCB
KAPOLEI HI
96707-2014
US

V. Phone/Fax

Practice location:
  • Phone: 808-674-9595
  • Fax: 808-674-9696
Mailing address:
  • Phone: 808-674-9595
  • Fax: 808-674-9696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2178
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: