Healthcare Provider Details

I. General information

NPI: 1629639505
Provider Name (Legal Business Name): VIVIAN YIP DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2019
Last Update Date: 06/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8975 W CHARLESTON BLVD STE 100
LAS VEGAS NV
89117-5473
US

IV. Provider business mailing address

2110 CAST PEBBLE DR
LAS VEGAS NV
89135-1135
US

V. Phone/Fax

Practice location:
  • Phone: 702-290-4212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7205
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: