Healthcare Provider Details

I. General information

NPI: 1952740821
Provider Name (Legal Business Name): YAP FAMILY PRACTICE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2979 LINDBERGH BLVD
SPRINGFIELD IL
62704-6556
US

IV. Provider business mailing address

2979 LINDBERGH BLVD
SPRINGFIELD IL
62704-6556
US

V. Phone/Fax

Practice location:
  • Phone: 217-725-1422
  • Fax:
Mailing address:
  • Phone: 217-725-1422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036087319
License Number StateIL

VIII. Authorized Official

Name: DR. DENNIS YAP
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 217-725-1422