Healthcare Provider Details

I. General information

NPI: 1043658891
Provider Name (Legal Business Name): MATTHEW HONG YIN YIP D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9018 N SKYVIEW AVE
KANSAS CITY MO
64154-8501
US

IV. Provider business mailing address

9018 N SKYVIEW AVE
KANSAS CITY MO
64154-8501
US

V. Phone/Fax

Practice location:
  • Phone: 816-741-5113
  • Fax:
Mailing address:
  • Phone: 816-741-5113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2013017901
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: